Most Relevant Information
Provider Data
| NPI Number: | 1003672486 |
| Provider Name: | LOGHAN MATYI REGISTERED NURSE |
| Entity Type: | Individual |
| Taxonomy Code: | 163W00000X |
| Specialty: | Registered Nurse |
| License Number: | 041454781 |
Most Important Dates
| Enumeration Date: | 02/23/2024 |
| Last Updated: | 02/23/2024 |
Provider Practice Location
2401 W MAIN ST
MARION
IL
629591188
Practice Location Phone/Fax
| Phone: | 6189975311 |
| Fax: |
Provider Mailing Location
2401 W MAIN ST
MARION
IL
629591188
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |