Provider Demographics
NPI:1467417782
Name:FERGUSON, ANGELA L (CRNA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:L
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S PARK ST
Mailing Address - Street 2:ST. MARYS HOSPITAL-DEAN MEDICAL CENTER
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1849
Mailing Address - Country:US
Mailing Address - Phone:608-258-6975
Mailing Address - Fax:608-258-5222
Practice Address - Street 1:700 S PARK ST
Practice Address - Street 2:ST. MARYS HOSPITAL-DEAN MEDICAL CENTER
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1849
Practice Address - Country:US
Practice Address - Phone:608-258-6975
Practice Address - Fax:608-258-5222
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI121864-030367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1467417782Medicaid
WI44319400Medicaid
WI099574150Medicare PIN
WI60104OtherDEAN HEALTH INSURANCE
WIP00050911Medicare PIN
P45309Medicare UPIN