Healthcare Provider Details

I. General information

NPI: 1487577342
Provider Name (Legal Business Name): SHAWNETTA FERGUSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5460 LAMME RD
MORAINE OH
45439-3217
US

IV. Provider business mailing address

5460 LAMME RD
MORAINE OH
45439-3217
US

V. Phone/Fax

Practice location:
  • Phone: 937-241-6528
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: