Provider Demographics
NPI:1558035634
Name:HELGE, LOGAN MARIE
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:MARIE
Last Name:HELGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 154TH
Mailing Address - Street 2:
Mailing Address - City:PLEASANT DALE
Mailing Address - State:NE
Mailing Address - Zip Code:68423-9113
Mailing Address - Country:US
Mailing Address - Phone:402-641-2189
Mailing Address - Fax:
Practice Address - Street 1:1240 ARIES DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-9100
Practice Address - Country:US
Practice Address - Phone:402-420-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE113404363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE113404OtherNEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES LICENSURE UNIT