Provider Demographics
NPI:1447849971
Name:LOGUT, DAIJA
Entity type:Individual
Prefix:
First Name:DAIJA
Middle Name:
Last Name:LOGUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SUMMERS CT APT 605
Mailing Address - Street 2:
Mailing Address - City:RANSON
Mailing Address - State:WV
Mailing Address - Zip Code:25438-5666
Mailing Address - Country:US
Mailing Address - Phone:304-579-7597
Mailing Address - Fax:
Practice Address - Street 1:51 SUMMERS CT APT 605
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-5666
Practice Address - Country:US
Practice Address - Phone:304-579-7597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant