Provider Demographics
NPI:1194618959
Name:LOGAN, BRIANNA ALIZAE
Entity type:Individual
Prefix:MRS
First Name:BRIANNA
Middle Name:ALIZAE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:ALIZAE
Other - Last Name:LOPES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:372 PONTIAC AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-2707
Mailing Address - Country:US
Mailing Address - Phone:401-345-1361
Mailing Address - Fax:
Practice Address - Street 1:100 KENYON AVE
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4299
Practice Address - Country:US
Practice Address - Phone:401-782-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-31
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program