Provider Demographics
NPI:1639971773
Name:FAGAN, ADAM
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:FAGAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9744 MOCKINGBIRD DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-2013
Mailing Address - Country:US
Mailing Address - Phone:402-800-3787
Mailing Address - Fax:
Practice Address - Street 1:10462 W ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-2926
Practice Address - Country:US
Practice Address - Phone:402-810-0473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion