MEDICARE: JANE S FERGUSON APRN/PC

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	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	174400	MA

General Provider Information

NPI Number	:	1447330287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE S FERGUSON APRN/PC

Provider Business Mailing Address
First Line	:	162 CHANDLER ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01609-2924
Country	:	US
Telephone Number	:	508-860-1215
Fax Number	:	508-860-1236

Provider Business Practice Location Address
First Line	:	162 CHANDLER ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01609-2924
Country	:	US
Telephone Number	:	508-860-1215
Fax Number	:	508-860-1236

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	02/01/2011

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