| NPI | 1235393364 |
|---|---|
| Former Name | VICTORIA ANN FAGAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 091076) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 091076) |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2008-09-15 |