Healthcare Provider Details

I. General information

NPI: 1730197484
Provider Name (Legal Business Name): LINDA M. FERGUSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 WOODLAND AVE
PHILADELPHIA PA
19104-4551
US

IV. Provider business mailing address

3900 WOODLAND AVE
PHILADELPHIA PA
19104-4551
US

V. Phone/Fax

Practice location:
  • Phone: 215-823-5999
  • Fax:
Mailing address:
  • Phone: 215-823-5999
  • Fax: 215-823-4265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP008851
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP008851
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberSP008851
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: