Provider Demographics
NPI: | 1083992093 |
---|---|
Name: | FERGUSON, SHARON (NP) |
Entity Type: | Individual |
Prefix: | |
First Name: | SHARON |
Middle Name: | |
Last Name: | FERGUSON |
Suffix: | |
Gender: | F |
Credentials: | NP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 571 SAINT JOSEPHS BLVD FL 2 |
Mailing Address - Street 2: | |
Mailing Address - City: | ELMIRA |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 14901-3230 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 607-271-2050 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 602 IVY ST |
Practice Address - Street 2: | |
Practice Address - City: | ELMIRA |
Practice Address - State: | NY |
Practice Address - Zip Code: | 14905-1646 |
Practice Address - Country: | US |
Practice Address - Phone: | 607-737-4577 |
Practice Address - Fax: | 607-737-4271 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2011-07-25 |
Last Update Date: | 2016-09-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 340819 | 363L00000X, 363LG0600X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | |
No | 363LG0600X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 03361180 | Medicaid | |
PA | 102818092 | Medicaid | |
NY | J400066932 | Medicare PIN |