Provider Demographics
NPI:1275840282
Name:FERGUSON, LISA L (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:L
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48811-0550
Mailing Address - Country:US
Mailing Address - Phone:989-584-3153
Mailing Address - Fax:989-584-3975
Practice Address - Street 1:221 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:MI
Practice Address - Zip Code:48811-0550
Practice Address - Country:US
Practice Address - Phone:989-584-3153
Practice Address - Fax:989-584-3975
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704167154364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health