Healthcare Provider Details

I. General information

NPI: 1457318768
Provider Name (Legal Business Name): VICTORIA FERGUSON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 NORTH BROAD STREET SUITE 224 BROAD STREET HEALTH CENTER
PHILADELPHIA PA
19122-3323
US

IV. Provider business mailing address

5619-25 VINE STREET SPECTRUM HEALTH SERVICES, INC.
PHILADELPHIA PA
19139-1302
US

V. Phone/Fax

Practice location:
  • Phone: 215-235-7944
  • Fax: 215-235-3361
Mailing address:
  • Phone: 215-471-2761
  • Fax: 215-471-2929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberMW010066
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: