Healthcare Provider Details

I. General information

NPI: 1023375102
Provider Name (Legal Business Name): GUINEVERE G FERGUSON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9293 STATE ROUTE 43 SUITE B
STREETSBORO OH
44241-5374
US

IV. Provider business mailing address

9293 STATE ROUTE 43 SUITE B
STREETSBORO OH
44241-5374
US

V. Phone/Fax

Practice location:
  • Phone: 330-626-1113
  • Fax: 330-626-1133
Mailing address:
  • Phone: 330-626-1113
  • Fax: 330-626-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN247694CDA1
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: