Provider Demographics
NPI:1073851739
Name:FERGUSON, MICHEL C (CNP)
Entity Type:Individual
Prefix:
First Name:MICHEL
Middle Name:C
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5735 MEEKER RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-1180
Mailing Address - Country:US
Mailing Address - Phone:937-548-3806
Mailing Address - Fax:937-548-3552
Practice Address - Street 1:5735 MEEKER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1180
Practice Address - Country:US
Practice Address - Phone:937-548-3806
Practice Address - Fax:937-548-3552
Is Sole Proprietor?:No
Enumeration Date:2013-01-30
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH331067363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0094397Medicaid
OHH219220Medicare PIN