Petel B Fagan

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

303492 Issued in NY

Practice address

54 Jennifer Cir
Rochester, NY 14606-3350

Phone

(585) 754-3391

NPI assigned

Dec 6, 2010

Last updated

Dec 6, 2010By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1291593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291593600000",
    "number": "1275836777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 JENNIFER CIR",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146063350",
            "telephone_number": "585-754-3391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 JENNIFER CIR",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146063350",
            "telephone_number": "585-754-3391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "PETEL",
        "middle_name": "B",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-12-06",
        "last_updated": "2010-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "303492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shanna S Fadgen, LPN
• Casey Sehlin Faessler, FNP
• Jeffrey Michael Fafinski, FNP
• Dawn Marie Fagan, LPN
• Martha Fagan, FNP
• Heather R Fagen, PHARMD
• Carol Diane Fague, RPA-C
• Kayleigh Fahey, N.P.
• Kristina A Fahy, MS, CCC-SLP
• Michael Patrick Fahy, ATC

• Licensed Practical Nurse in Rochester, NY
• Providers in Rochester, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.