Provider Demographics
NPI:1528033313
Name:LOGAN, LEONA RENATE (CNM)
Entity Type:Individual
Prefix:
First Name:LEONA
Middle Name:RENATE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:LEONA
Other - Middle Name:RENATE
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:817 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-2800
Mailing Address - Country:US
Mailing Address - Phone:814-535-5545
Mailing Address - Fax:814-535-5574
Practice Address - Street 1:817 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-2800
Practice Address - Country:US
Practice Address - Phone:814-535-5545
Practice Address - Fax:814-535-5574
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW008414L367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01815173Medicaid
PA1384812OtherHIGHMARK
S60843Medicare UPIN
PA01815173Medicaid