Provider Demographics
NPI:1053618553
Name:LOGAN-BELFORD, ANITA GAIL (RN-BC)
Entity type:Individual
Prefix:MS
First Name:ANITA
Middle Name:GAIL
Last Name:LOGAN-BELFORD
Suffix:
Gender:F
Credentials:RN-BC
Other - Prefix:MS
Other - First Name:ANITA
Other - Middle Name:GAIL
Other - Last Name:WISEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-0329
Mailing Address - Country:US
Mailing Address - Phone:509-524-2920
Mailing Address - Fax:509-524-2993
Practice Address - Street 1:1520 KELLEY PL
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-8654
Practice Address - Country:US
Practice Address - Phone:509-524-2920
Practice Address - Fax:509-524-2993
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00073556163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA251B00000XMedicaid
WA251S00000XMedicaid
WA8853859Medicare PIN