Provider Demographics
NPI:1710799721
Name:LOGAN, DOLA (LPN)
Entity type:Individual
Prefix:
First Name:DOLA
Middle Name:
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:DOLA
Other - Middle Name:
Other - Last Name:BLAKEMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:912 SCOTCH PINE CT
Mailing Address - Street 2:
Mailing Address - City:SANDSTON
Mailing Address - State:VA
Mailing Address - Zip Code:23150-1672
Mailing Address - Country:US
Mailing Address - Phone:757-675-5227
Mailing Address - Fax:
Practice Address - Street 1:8406 CAPERNWRAY DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23838-5612
Practice Address - Country:US
Practice Address - Phone:804-912-7067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-25
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002077889164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse