Provider Demographics
NPI:1457689226
Name:LOGAN, MARY ALEXANDRA (PCD(DONA))
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ALEXANDRA
Last Name:LOGAN
Suffix:
Gender:F
Credentials:PCD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2976
Mailing Address - Country:US
Mailing Address - Phone:503-943-9392
Mailing Address - Fax:
Practice Address - Street 1:1822 E 32ND ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2976
Practice Address - Country:US
Practice Address - Phone:503-943-9392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-06
Last Update Date:2009-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602966552374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula