Provider Demographics
NPI:1376968354
Name:FERGUSON, DARRIN (RN)
Entity Type:Individual
Prefix:
First Name:DARRIN
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17764 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:SHASTA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:96089-5793
Mailing Address - Country:US
Mailing Address - Phone:530-275-4328
Mailing Address - Fax:
Practice Address - Street 1:17764 PINE AVE.
Practice Address - Street 2:
Practice Address - City:SHASTA LAKE
Practice Address - State:CA
Practice Address - Zip Code:96089-5793
Practice Address - Country:US
Practice Address - Phone:530-275-4328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA537129163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse