Provider Demographics
NPI:1437552635
Name:FERGUSON, JACQUELINE (LPN-M-IV)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LPN-M-IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 W BOWERY ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-2573
Mailing Address - Country:US
Mailing Address - Phone:330-996-4600
Mailing Address - Fax:330-253-6606
Practice Address - Street 1:147 PARK ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1943
Practice Address - Country:US
Practice Address - Phone:330-996-4600
Practice Address - Fax:330-253-6606
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.141492-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse