Individual
MRS. DIANNE M FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
2310 NOTT ST E, SUITE 100, NISKAYUNA, NY 12309-4303
(518) 526-0004
(518) 381-9554
Mailing address
1184 ROSEHILL BLVD, NISKAYUNA, NY 12309-4624
(518) 382-0327
(518) 381-9554
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
968021
MVP HEALTHCARE
NY
Enumeration date
11/28/2006
Last updated
03/05/2008
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