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General NPI Number Information
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NPI Number | 1194744755
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Entity Type | Individual
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Provider Name | JUDITH FAGEN NP
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Gender | Female
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 570 W BROWN RD
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City | MESA
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State | AZ
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Zip | 85201-3227
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Country | US
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Telephone | 480-344-2007
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Fax |
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Provider Business Mailing Address
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Address Line | 3255 E ELWOOD ST #110
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City | PHOENIX
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State | AZ
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Zip | 85034-7256
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Country | US
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Telephone | 602-470-5043
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Fax | 602-470-5064
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | AZ
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