Provider Demographics
NPI:1770256687
Name:LINDGREN, LOGEN L
Entity Type:Individual
Prefix:
First Name:LOGEN
Middle Name:L
Last Name:LINDGREN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-1134
Mailing Address - Country:US
Mailing Address - Phone:190-774-3299
Mailing Address - Fax:
Practice Address - Street 1:3609 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-1134
Practice Address - Country:US
Practice Address - Phone:190-774-3299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider