Provider Demographics
NPI:1417145939
Name:LOGAN, SHERYL E (NP)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:E
Last Name:LOGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601067
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1067
Mailing Address - Country:US
Mailing Address - Phone:704-373-0212
Mailing Address - Fax:704-373-1216
Practice Address - Street 1:1001 BLYTHE BLVD
Practice Address - Street 2:SUITE 300-ADULT CARDIOLOGY
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5866
Practice Address - Country:US
Practice Address - Phone:704-373-0212
Practice Address - Fax:704-373-1216
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN093611363LF0000X
NC5005997363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2228Medicaid
GA695626868A(MARIETTA)Medicaid
GA695626868E(AUSTELL)Medicaid
GA695626868D-DOUGLASMedicaid
NC7006531Medicaid
GA695626868B(WOODSTOCKMedicaid
NC1417145939Medicaid
GA695626868C(HIRAM)Medicaid
NC1417145939Medicaid