| NPI | 1316216930 |
|---|---|
| Former Name | HOLLIE C FAGAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 015435) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 15435) |
| Enumeration Date | 2011-12-28 |
| Last Update Date | 2023-07-06 |