Provider Demographics
NPI:1699110536
Name:FAGAN, SUSAN C (RN)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:C
Last Name:FAGAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 CHEVELLE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7805
Mailing Address - Country:US
Mailing Address - Phone:225-343-9505
Mailing Address - Fax:225-343-9141
Practice Address - Street 1:1040 CHEVELLE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7805
Practice Address - Country:US
Practice Address - Phone:225-343-9505
Practice Address - Fax:225-343-9141
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA094363163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse