Provider Demographics
NPI:1578109849
Name:PAGAN, MINALY (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MINALY
Middle Name:
Last Name:PAGAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-1085
Mailing Address - Country:US
Mailing Address - Phone:413-858-0000
Mailing Address - Fax:413-589-0912
Practice Address - Street 1:627 RANDALL RD
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-1085
Practice Address - Country:US
Practice Address - Phone:413-858-0000
Practice Address - Fax:413-589-0912
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN251702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily