Provider Demographics
NPI:1417728452
Name:LOGAN, STARLETT PAIGE (LPN)
Entity Type:Individual
Prefix:
First Name:STARLETT
Middle Name:PAIGE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:STARLETT
Other - Middle Name:PAIGE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1125 LAGOON AVE UNIT 206
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-5144
Mailing Address - Country:US
Mailing Address - Phone:769-229-5640
Mailing Address - Fax:
Practice Address - Street 1:2680 ARTHUR ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1339
Practice Address - Country:US
Practice Address - Phone:651-917-3634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN512789164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse