Provider Demographics
NPI:1295580041
Name:LOGAN, HOLLY MAUREEN (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:MAUREEN
Last Name:LOGAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 E NISHNA RD
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:IA
Mailing Address - Zip Code:51601-2541
Mailing Address - Country:US
Mailing Address - Phone:712-313-0053
Mailing Address - Fax:
Practice Address - Street 1:600 W SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:IA
Practice Address - Zip Code:51601-1708
Practice Address - Country:US
Practice Address - Phone:712-246-0159
Practice Address - Fax:712-581-9084
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG179028363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health