Provider Demographics
NPI:1801691498
Name:SULLIVAN, LOGAN MCCASLEN
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:MCCASLEN
Last Name:SULLIVAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 VILLAGE WAY APT B
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-4045
Mailing Address - Country:US
Mailing Address - Phone:308-249-3480
Mailing Address - Fax:
Practice Address - Street 1:1276 VILLAGE WAY APT B
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-4045
Practice Address - Country:US
Practice Address - Phone:308-249-3480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion