Provider Demographics
NPI:1215734561
Name:FAGAN, JANNA (RN)
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:
Last Name:FAGAN
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 224864
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75222-4864
Mailing Address - Country:US
Mailing Address - Phone:682-405-4998
Mailing Address - Fax:
Practice Address - Street 1:2379 GUS THOMASSON RD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-5302
Practice Address - Country:US
Practice Address - Phone:682-405-4998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX611241163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health