Provider Demographics
NPI:1033957691
Name:FAGAN, MAURA CATHARINE (PAC)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:CATHARINE
Last Name:FAGAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WULFSOHN RD APT C408
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-9015
Mailing Address - Country:US
Mailing Address - Phone:814-319-2068
Mailing Address - Fax:
Practice Address - Street 1:2001 N HORSESHOE TRL
Practice Address - Street 2:
Practice Address - City:SILT
Practice Address - State:CO
Practice Address - Zip Code:81652-9832
Practice Address - Country:US
Practice Address - Phone:970-876-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant