Provider Demographics
NPI:1215820477
Name:GEIKEN, LOGAN NICOLE
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:NICOLE
Last Name:GEIKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LOGAN
Other - Middle Name:NICOLE
Other - Last Name:SANFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3524 S STARKEY RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47932-8029
Mailing Address - Country:US
Mailing Address - Phone:217-274-1146
Mailing Address - Fax:
Practice Address - Street 1:440 W SONGER LN
Practice Address - Street 2:
Practice Address - City:VEEDERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47987-8547
Practice Address - Country:US
Practice Address - Phone:765-762-4180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71016669A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily