Provider Demographics
NPI:1003227661
Name:FERGUSON, SHENICE (RN)
Entity Type:Individual
Prefix:
First Name:SHENICE
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 S SHADOW GROVE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-2429
Mailing Address - Country:US
Mailing Address - Phone:832-971-8743
Mailing Address - Fax:
Practice Address - Street 1:2215 S SHADOW GROVE LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-2429
Practice Address - Country:US
Practice Address - Phone:832-971-8743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator