Provider Demographics
NPI:1669062527
Name:LOGAN, TANGELA H (RN)
Entity type:Individual
Prefix:
First Name:TANGELA
Middle Name:H
Last Name:LOGAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6765 CORPORATE BLVD APT 9104
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1084
Mailing Address - Country:US
Mailing Address - Phone:469-658-9710
Mailing Address - Fax:
Practice Address - Street 1:6765 CORPORATE BLVD APT 9104
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1084
Practice Address - Country:US
Practice Address - Phone:985-402-1808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA060014163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management