Healthcare Provider Details

I. General information

NPI: 1942653415
Provider Name (Legal Business Name): CAROLYN A FERGUSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 H ST
FAIRBURY NE
68352-1119
US

IV. Provider business mailing address

PO BOX 277
FAIRBURY NE
68352-0277
US

V. Phone/Fax

Practice location:
  • Phone: 402-729-3351
  • Fax: 402-729-2102
Mailing address:
  • Phone: 402-729-3351
  • Fax: 402-729-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95004452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: