Provider Demographics
NPI:1518656529
Name:LOGRANDE, GINAMARIE (MS, CNS CANDIDATE)
Entity Type:Individual
Prefix:
First Name:GINAMARIE
Middle Name:
Last Name:LOGRANDE
Suffix:
Gender:F
Credentials:MS, CNS CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3961 E CHANDLER BLVD STE 111-213
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0303
Mailing Address - Country:US
Mailing Address - Phone:602-643-8134
Mailing Address - Fax:
Practice Address - Street 1:5250 S TOPAZ PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-5452
Practice Address - Country:US
Practice Address - Phone:602-643-8134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist