Healthcare Provider Details

I. General information

NPI: 1184463663
Provider Name (Legal Business Name): GLORIA FERGUSON LPN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

756 DAVIES AVE
AKRON OH
44306-2704
US

IV. Provider business mailing address

756 DAVIES AVE
AKRON OH
44306-2704
US

V. Phone/Fax

Practice location:
  • Phone: 234-788-8712
  • Fax: 234-788-8712
Mailing address:
  • Phone: 234-334-5589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number543265
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number179403
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: