Provider Demographics
NPI:1689284515
Name:LOGAN, SAVANNAH NICOLE
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:NICOLE
Last Name:LOGAN
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 1:3250 JEFFERSON AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-2993
Mailing Address - Country:US
Mailing Address - Phone:330-639-9322
Mailing Address - Fax:
Practice Address - Street 1:1019 LINN ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45203-1314
Practice Address - Country:US
Practice Address - Phone:513-233-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program