Provider Demographics
NPI:1013568203
Name:PAGAN, CONNIE SUE
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:SUE
Last Name:PAGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28040 ETTA OAKS LN
Mailing Address - Street 2:
Mailing Address - City:SPLENDORA
Mailing Address - State:TX
Mailing Address - Zip Code:77372-5200
Mailing Address - Country:US
Mailing Address - Phone:281-689-7900
Mailing Address - Fax:
Practice Address - Street 1:28040 ETTA OAKS LN
Practice Address - Street 2:
Practice Address - City:SPLENDORA
Practice Address - State:TX
Practice Address - Zip Code:77372-5200
Practice Address - Country:US
Practice Address - Phone:281-689-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty