Provider Demographics
NPI:1023375102
Name:FERGUSON, GUINEVERE G (CNP)
Entity Type:Individual
Prefix:MISS
First Name:GUINEVERE
Middle Name:G
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9293 STATE ROUTE 43
Mailing Address - Street 2:SUITE B
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-5374
Mailing Address - Country:US
Mailing Address - Phone:330-626-1113
Mailing Address - Fax:330-626-1133
Practice Address - Street 1:9293 STATE ROUTE 43
Practice Address - Street 2:SUITE B
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5374
Practice Address - Country:US
Practice Address - Phone:330-626-1113
Practice Address - Fax:330-626-1133
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN247694CDA1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner