Provider Demographics
NPI:1679818769
Name:LOGAN, CHRISTINE ODELL (RN, ICCE, CLC, ICPD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ODELL
Last Name:LOGAN
Suffix:
Gender:F
Credentials:RN, ICCE, CLC, ICPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8554 S BRENTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-6224
Mailing Address - Country:US
Mailing Address - Phone:720-371-7289
Mailing Address - Fax:
Practice Address - Street 1:8554 S BRENTWOOD ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-6224
Practice Address - Country:US
Practice Address - Phone:720-371-7289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula