Healthcare Provider Details

I. General information

NPI: 1760510440
Provider Name (Legal Business Name): REBECCA L. FERGUSON C.F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E CARPENTER
SPRINGFIELD IL
62769-0001
US

IV. Provider business mailing address

2329 N DIRKSEN PKWY
SPRINGFIELD IL
62702-1403
US

V. Phone/Fax

Practice location:
  • Phone: 217-544-6464
  • Fax: 217-757-6812
Mailing address:
  • Phone: 217-789-1403
  • Fax: 217-789-1825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number322591
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-004743
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: