Healthcare Provider Details

I. General information

NPI: 1073173373
Provider Name (Legal Business Name): JOHN FERGUSON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE
RALEIGH NC
27610-1231
US

IV. Provider business mailing address

1633 BLACK SPRUCE WAY
WILLOW SPRING NC
27592-7471
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-8484
  • Fax:
Mailing address:
  • Phone: 954-639-6823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number234993
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN9289278
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number234993
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: