Healthcare Provider Details

I. General information

NPI: 1811069594
Provider Name (Legal Business Name): CECELIA DENISE FERGUSON RN,BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11255 KETTERING PL
UPPER MARLBORO MD
20774-1578
US

IV. Provider business mailing address

11255 KETTERING PL
UPPER MARLBORO MD
20774-1578
US

V. Phone/Fax

Practice location:
  • Phone: 301-728-4651
  • Fax: 301-336-5349
Mailing address:
  • Phone: 301-728-4651
  • Fax: 301-336-5349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN47490
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code163WN0300X
TaxonomyNephrology Registered Nurse
License NumberRN47490
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: