Healthcare Provider Details

I. General information

NPI: 1295798288
Provider Name (Legal Business Name): SHERI LYNN FERGUSON R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DR. MARY E. WALKER CENTER BLDG 170
FORT IRWIN CA
92310
US

IV. Provider business mailing address

4035 ALVORD DR
FORT IRWIN CA
92310-1531
US

V. Phone/Fax

Practice location:
  • Phone: 760-380-7475
  • Fax:
Mailing address:
  • Phone: 760-380-7475
  • Fax: 760-380-7349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number28089745A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: