Healthcare Provider Details

I. General information

NPI: 1962870345
Provider Name (Legal Business Name): BRENDA JEAN FERGUSON ACNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HIGHLAND ST
CLINTON MA
01510-1037
US

IV. Provider business mailing address

PO BOX 415348
BOSTON MA
02241-5348
US

V. Phone/Fax

Practice location:
  • Phone: 978-466-4169
  • Fax: 978-466-4164
Mailing address:
  • Phone: 2-258-8858
  • Fax: 508-334-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN187521
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: