Provider Demographics
NPI:1295515062
Name:LOGAN MILTON, DARLISA MARIE
Entity type:Individual
Prefix:
First Name:DARLISA
Middle Name:MARIE
Last Name:LOGAN MILTON
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 1:593 GARDENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-3922
Mailing Address - Country:US
Mailing Address - Phone:330-990-6955
Mailing Address - Fax:
Practice Address - Street 1:593 GARDENDALE AVE # A
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-3922
Practice Address - Country:US
Practice Address - Phone:330-990-6955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401265900711376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide