Healthcare Provider Details

I. General information

NPI: 1043606668
Provider Name (Legal Business Name): ALICIA MARIE FERGUSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 CLIPPER SHIP CT
ANCHORAGE AK
99515-3623
US

IV. Provider business mailing address

611 CLIPPER SHIP CT
ANCHORAGE AK
99515-3623
US

V. Phone/Fax

Practice location:
  • Phone: 907-306-1274
  • Fax:
Mailing address:
  • Phone: 907-306-1274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209014383
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2016013656
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number450
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: