Courtney Fagan, REGISTERED NURSE

Primary specialty

Diabetes Educator Registered NurseTaxonomy code 163WD0400X

License

184877-30 Issued in WI

Practice address

3805 Spring Street
BLDG a - Suite 311
Racine, WI 53405-1600

Phone

(262) 687-6345

NPI assigned

Jun 25, 2018

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": "1529884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529884800000",
    "number": "1972098697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6316 37TH AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531423364",
            "telephone_number": "262-752-7240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3805 SPRING STREET",
            "address_2": "BLDG A - SUITE 311",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534051600",
            "telephone_number": "262-687-6345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "COURTNEY",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-25",
        "last_updated": "2018-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "WI",
            "license": "184877-30",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Evolve365 Therapy LLC
• Excel Health Services
• Eye Care Surgical Consulting SC
• Eye Care Surgical Consulting, S.C.
• Eyeopenerz
• Familia Dental Racine LLC
• Family Care Associates, Inc.
• Family Eye Care Center of Racine Inc
• Family First Home Healthcare, LLC
• Family Foot Clinics of Wisconsin SC

• Diabetes Educator Registered Nurse in Racine, WI
• Providers in Racine, WI by specialty
• Diabetes Educator Registered Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2018; 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.