Provider Demographics
NPI:1366760274
Name:FAGAN, REBECCA ALL (LPN)
Entity type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:ALL
Last Name:FAGAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-2312
Mailing Address - Country:US
Mailing Address - Phone:330-581-8189
Mailing Address - Fax:
Practice Address - Street 1:347 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-2312
Practice Address - Country:US
Practice Address - Phone:330-581-8189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-125223-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse