MEDICARE: BRITTNEY FERGUSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver		IN

General Provider Information

NPI Number	:	1255874681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTNEY FERGUSON

Provider Business Mailing Address
First Line	:	601 E TABER ST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46803-2408
Country	:	US
Telephone Number	:	260-702-0925
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 E TABER ST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46803-2408
Country	:	US
Telephone Number	:	260-702-0925
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2016
Last Update Date	:	12/03/2016

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