Provider Demographics
NPI:1447735436
Name:DEGE PEARL, LOGAN (DNP)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:DEGE PEARL
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:LOGAN
Other - Middle Name:
Other - Last Name:PEARL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:165 SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-9811
Mailing Address - Country:US
Mailing Address - Phone:802-748-9405
Mailing Address - Fax:
Practice Address - Street 1:185 SHERMAN DR
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-9811
Practice Address - Country:US
Practice Address - Phone:802-748-5041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0134212363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily