Provider Demographics
NPI:1669546867
Name:AGAN, NOELLE R (MS, CGC)
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:R
Last Name:AGAN
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2907 E JOYCE BLVD
Mailing Address - Street 2:BLDG II
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5011
Mailing Address - Country:US
Mailing Address - Phone:479-684-5166
Mailing Address - Fax:479-973-2885
Practice Address - Street 1:2907 E JOYCE BLVD
Practice Address - Street 2:BLDG II
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5011
Practice Address - Country:US
Practice Address - Phone:479-684-5166
Practice Address - Fax:479-973-2885
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS