Individual
VIRGINIA SUE FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
29 RESTER RD, PERKINSTON, MS 39573-4947
(228) 343-3105
Mailing address
29 RESTER RD, PERKINSTON, MS 39573-4947
(228) 343-3105
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
—
—
3747P1801X
Personal Care Attendant
Primary
—
MS
Other
Enumeration date
10/17/2022
Last updated
10/20/2022
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