Healthcare Provider Details

I. General information

NPI: 1316655095
Provider Name (Legal Business Name): REBECCA FERGUSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA CHILDRESS

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S MCQUEEN RD
GILBERT AZ
85233-6506
US

IV. Provider business mailing address

1461 S LA ARBOLETA DR
GILBERT AZ
85296-4183
US

V. Phone/Fax

Practice location:
  • Phone: 480-632-4750
  • Fax: 480-892-6533
Mailing address:
  • Phone: 540-818-6022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number245281
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number245281
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: