Individual
JACQUELYN ALLYSE FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, CD, CEP
Contact information
Practice address
2202 S CEDAR ST, SUITE 300, TACOMA, WA 98405-2318
(253) 301-5280
Mailing address
2202 S CEDAR ST STE 300, TACOMA, WA 98405-2318
(253) 301-5280
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DI 60713040
WA
Other
Enumeration date
12/15/2016
Last updated
03/19/2025
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