Healthcare Provider Details

I. General information

NPI: 1811558422
Provider Name (Legal Business Name): EMMA ROSE FERGUSON I FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

PO BOX 227
JACKSONVILLE VT
05342-0227
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-3790
  • Fax:
Mailing address:
  • Phone: 802-579-3029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0134341
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number101.0134341
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: