Individual
TERRI B FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2825 E BARNETT RD, MEDFORD, OR 97504-8332
(541) 789-7000
Mailing address
100 E MAIN ST, SUITE C, MEDFORD, OR 97501-6041
(541) 789-7000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
9500954N1
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078071
—
OR
Enumeration date
03/02/2007
Last updated
07/08/2007
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