Provider Demographics
NPI:1093739997
Name:FERGUSON, TANDA M (ARNP)
Entity Type:Individual
Prefix:
First Name:TANDA
Middle Name:M
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2947
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98907-2947
Mailing Address - Country:US
Mailing Address - Phone:509-248-7849
Mailing Address - Fax:509-249-5042
Practice Address - Street 1:3909 CREEKSIDE LOOP
Practice Address - Street 2:SUITE 130
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4880
Practice Address - Country:US
Practice Address - Phone:509-248-6616
Practice Address - Fax:509-248-4983
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006204363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner