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General NPI Number Information
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NPI Number | 1750560090
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Entity Type | Individual
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Provider Name | MONICA C FERGUSON NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 11/02/2007
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Last Update Date | 03/26/2012
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Provider Practice Location Address
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Address Line | 103 GARLAND ST
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City | EVERETT
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State | MA
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Zip | 02149-5066
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Country | US
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Telephone | 781-729-9426
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Fax |
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Provider Business Mailing Address
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Address Line | 2 PILGRIM DR
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City | WINCHESTER
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State | MA
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Zip | 01890-3320
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Country | US
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Telephone | 781-729-9426
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 172250
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License Number State | MA
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