MEDICARE: SUSAN FERGUSON R 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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	NP02429	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NP02429	OTHER	OH	MEDICAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649275033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN FERGUSON R NP

Provider Business Mailing Address
First Line	:	3045 OLENTANGY RIVER RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1552
Country	:	US
Telephone Number	:	614-268-8800
Fax Number	:	614-268-8249

Provider Business Practice Location Address
First Line	:	3045 OLENTANGY RIVER RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1552
Country	:	US
Telephone Number	:	614-268-8800
Fax Number	:	614-268-8249

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/08/2007

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