Provider Demographics
NPI:1861808180
Name:LOGAN, LESLIE MARIE (CNM)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:MARIE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MISS
Other - First Name:LESLIE
Other - Middle Name:MARIE
Other - Last Name:MCANDREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2500 METROHEALTH DR
Mailing Address - Street 2:NURSING BUSINESS OFFICE, HAMMAN BLDG
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-1900
Mailing Address - Country:US
Mailing Address - Phone:216-778-3356
Mailing Address - Fax:
Practice Address - Street 1:2500 METROHEALTH DR
Practice Address - Street 2:NURSING BUSINESS OFFICE, HAMMAN BLDG
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1900
Practice Address - Country:US
Practice Address - Phone:216-778-3356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.219425-COA1163WP1700X
OHNM16157367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WP1700XNursing Service ProvidersRegistered NursePerinatal