Individual provider · NPI-1
Courtney Fagan, Registered Nurse
Registered Nurse, Diabetes Educator · Racine, WI
NPI number1972098697
StatusActive
Last updated in NPPESJun 25, 2018
Details
- NPI
- 1972098697
- Entity type
- Individual (NPI-1)
- Name
- Courtney Fagan
- Credential
- Registered Nurse
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jun 25, 2018
- Last updated
- Jun 25, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 163WD0400X | Registered Nurse, Diabetes Educator | 184877-30 | WI | Yes |
Practice location
3805 Spring StreetBldg A - Suite 311
Racine, WI 53405-1600
Phone 262-687-6345
Mailing address
6316 37th AveKenosha, WI 53142-3364
Phone 262-752-7240
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