Healthcare Provider Details

I. General information

NPI: 1942528617
Provider Name (Legal Business Name): ALICIA FERGUSON BSN,RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2666 MERRIMAC BLVD
TOLEDO OH
43606-3640
US

IV. Provider business mailing address

2666 MERRIMAC BLVD
TOLEDO OH
43606-3640
US

V. Phone/Fax

Practice location:
  • Phone: 419-280-4612
  • Fax:
Mailing address:
  • Phone: 419-280-4612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN358844
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: