Provider Demographics
NPI:1477559805
Name:LOGAN, MARGARET B (FNP)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:B
Last Name:LOGAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102A ASTOR ST
Mailing Address - Street 2:
Mailing Address - City:WELLFORD
Mailing Address - State:SC
Mailing Address - Zip Code:29385-9622
Mailing Address - Country:US
Mailing Address - Phone:864-439-5338
Mailing Address - Fax:
Practice Address - Street 1:102A ASTOR ST
Practice Address - Street 2:
Practice Address - City:WELLFORD
Practice Address - State:SC
Practice Address - Zip Code:29385-9622
Practice Address - Country:US
Practice Address - Phone:864-439-5338
Practice Address - Fax:864-439-4769
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN1908363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0713Medicaid
SCNP0713Medicaid
SC6521Medicare PIN
SCP95736Medicare UPIN
SC6499Medicare PIN
SC5172Medicare PIN