Individual
DR. KATHLEEN ANNE FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNSC, RN, BC, APN
Contact information
Practice address
241 MOORE ST, HACKENSACK, NJ 07601-7533
(201) 342-2478
Mailing address
188 DEERFIELD TER, MAHWAH, NJ 07430-2853
(210) 694-7920
(201) 934-6691
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
26NN09492700
NJ
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
26NN09492700
NJ
Other
Enumeration date
01/11/2010
Last updated
01/11/2010
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