Provider Demographics
NPI:1750679080
Name:LOGRONO, AL-MARIE GRACE TINGSON (MD)
Entity Type:Individual
Prefix:
First Name:AL-MARIE GRACE
Middle Name:TINGSON
Last Name:LOGRONO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 DEMERS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201
Mailing Address - Country:US
Mailing Address - Phone:701-780-1891
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:1001 7TH ST NE - ALTRU CLINIC/DEVILS LAKE
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301
Practice Address - Country:US
Practice Address - Phone:701-662-2157
Practice Address - Fax:810-342-5810
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND13139207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine