IndividualActive
Prudence Logan, ST
NPI 1457658288 · Surgical Technologist · Normal, IL
Provider details
- NPI number
- 1457658288
- Entity type
- Individual
- Primary specialty
- Surgical TechnologistTechnologists, Technicians & Other Technical Service Providers
- Credential
- ST
- Sex
- Female
- Sole proprietor
- Yes
Specialties & taxonomies
Technologists, Technicians & Other Technical Service Providers
Practice location
112 Boeykens Pl Ste 2a
Normal, IL 61761-2152
Phone: (309) 846-4716
Fax: (309) 454-7348
Approximate (ZIP-level) locationGet directions
Mailing address
112 Boeykens Pl Ste 2a
Normal, IL 61761-2152
Registry dates
- Enumerated
- 2011-02-14
- Last updated
- 2011-02-14
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.