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General NPI Number Information
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NPI Number | 1194554550
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Entity Type | Individual
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Provider Name | HEATHER ROSE FERGUSON FNP
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Gender | Female
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Dates
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Enumeration Date | 08/01/2024
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 331 STEWART RD
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City | MONROE
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State | MI
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Zip | 48162-4393
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Country | US
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Telephone | 734-410-7009
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Fax | 734-410-7003
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Provider Business Mailing Address
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Address Line | 23993 THORN DR
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City | BROWNSTOWN TOWNSHIP
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State | MI
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Zip | 48134-6038
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Country | US
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Telephone | 313-231-6617
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704337293
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License Number State | MI
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