Sue Fagan, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

000032127N1 Issued in OR

Practice address

426 SW Stark St
8TH Floor
Portland, OR 97204-2347

Phone

(503) 988-3674

Fax

(503) 988-5484

NPI assigned

Jan 19, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578441600000",
    "number": "1891848081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "619 NW 6TH AVE",
            "address_2": "FL 5",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972093964",
            "telephone_number": "503-988-7468",
            "fax_number": "503-988-3015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "426 SW STARK ST",
            "address_2": "8TH FLOOR",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972042347",
            "telephone_number": "503-988-3674",
            "fax_number": "503-988-5484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "SUE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2020-01-08",
        "certification_date": "2020-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "000032127N1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "22959",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ruthanne Fackler, RN
• Ma Alejandra Facundo Mendez, CHW, PSS
• Collaine Brooke Faddis, LMT
• Emily Fagan, LPC
• Paul Fagan, MA, LPC
• Goldis Faghihi, ND, DC
• Lyle James Fagnan, MD
• Diana Marie Fahey, CADC-R
• Sara Fahey, C.N.M., ARNP
• Thomas R Fahrbach, MD

• Family Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2020; 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.