Provider Demographics
NPI:1407530934
Name:POCKL, LOGAN ELYSE (APNP)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:ELYSE
Last Name:POCKL
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9916 75TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7583
Mailing Address - Country:US
Mailing Address - Phone:262-942-4000
Mailing Address - Fax:262-942-7740
Practice Address - Street 1:9916 75TH ST STE 205
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7583
Practice Address - Country:US
Practice Address - Phone:262-942-4000
Practice Address - Fax:262-942-7740
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14082-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health