Healthcare Provider Details

I. General information

NPI: 1861416786
Provider Name (Legal Business Name): JANET FERGUSON C.N.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W SUPERIOR ST
CHICAGO IL
60622-5646
US

IV. Provider business mailing address

326 S RIDGELAND AVE
OAK PARK IL
60302-3546
US

V. Phone/Fax

Practice location:
  • Phone: 312-666-3494
  • Fax: 312-666-6228
Mailing address:
  • Phone: 708-524-8328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209-002760
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209002760
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: