Individual ProviderLogan JoldersmaPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address22 Bramhall St, Portland, ME 04102-3134(207) 662-2381(505) 992-0233PECOS EnrollmentBased on the most recent information from CMS, provider Logan Joldersma is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 2:35 PM.Profile DetailsProvider ID1063034114Provider TypeIndividualFull NameJoldersma, LoganGenderMaleSole ProprietorNoEnumeration Date5/12/2020Last Updated8/15/2025Contact InformationPractice LocationPractice Address22 Bramhall St, Portland, ME 04102-3134Phone(207) 662-2381FaxUnlisted FaxMailing LocationMailing Address330 Garfield St Ste 202, Santa Fe, NM 87501-2677Phone(505) 992-0233FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicensePA2025-0056New Mexico