Individual provider · NPI-1

Dr. Kathleen Anne Fagan, DNSc, RN, BC, APN

Nurse Practitioner, Women's Health · Hackensack, NJ

NPI number1386974517
StatusActive
Last updated in NPPESJan 11, 2010

Details

NPI
1386974517
Entity type
Individual (NPI-1)
Name
Dr. Kathleen Anne Fagan
Credential
DNSc, RN, BC, APN
Sex
Female
Sole proprietor
No
Enumeration date
Jan 11, 2010
Last updated
Jan 11, 2010

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LW0102X Nurse Practitioner, Women's Health26NN09492700NJYes
363LX0001X Nurse Practitioner, Obstetrics & Gynecology26NN09492700NJ

Practice location

241 Moore St
Hackensack, NJ 07601-7533

Phone 201-342-2478

Mailing address

188 Deerfield Ter
Mahwah, NJ 07430-2853

Phone 210-694-7920 · Fax 201-934-6691

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