Basic Information
| Provider Information | |||||||||
| NPI: | 1558035634 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HELGE | ||||||||
| FirstName: | LOGAN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1245 154TH | ||||||||
| Address2: | |||||||||
| City: | PLEASANT DALE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 684239113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4026412189 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1240 ARIES DR | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685129100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024201300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2021 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 113404 | NE | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 113404 | 01 | NE | NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES LICENSURE UNIT | OTHER |