Provider Demographics
NPI:1417773565
Name:FAGANS, ANGELA M
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:M
Last Name:FAGANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14164 RUTHERFORD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-1844
Mailing Address - Country:US
Mailing Address - Phone:734-469-8820
Mailing Address - Fax:
Practice Address - Street 1:14164 RUTHERFORD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-1844
Practice Address - Country:US
Practice Address - Phone:734-469-8820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker