MEDICARE: SARAH FERGUSON NP

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	363L00000X	Nurse Practitioner	209004232	IL

General Provider Information

NPI Number	:	1518072206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH FERGUSON NP

Provider Business Mailing Address
First Line	:	13707 W JACKSON ST
Second Line	:
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-3188
Country	:	US
Telephone Number	:	815-337-1871
Fax Number	:	815-338-6297

Provider Business Practice Location Address
First Line	:	360 STATION DR
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-7978
Country	:	US
Telephone Number	:	815-356-5382
Fax Number	:	815-356-2385

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	05/08/2009

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