Provider Demographics
NPI:1508961236
Name:FAGAN-PRYOR, ELLEN CATHERINE (MSN, PMHCNS, RN)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:CATHERINE
Last Name:FAGAN-PRYOR
Suffix:
Gender:F
Credentials:MSN, PMHCNS, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8818 HOFFMAN RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46816-9595
Mailing Address - Country:US
Mailing Address - Phone:260-639-6767
Mailing Address - Fax:
Practice Address - Street 1:2121 LAKE AVENE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5100
Practice Address - Country:US
Practice Address - Phone:260-445-2123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28101257A163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult