Individual
COURTNEY FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
3805 SPRING STREET, BLDG A - SUITE 311, RACINE, WI 53405-1600
(262) 687-6345
Mailing address
6316 37TH AVE, KENOSHA, WI 53142-3364
(262) 752-7240
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
Primary
184877-30
WI
Other
Enumeration date
06/25/2018
Last updated
06/25/2018
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