Provider Demographics
NPI:1598975856
Name:FERGUSON, NICOLE CHRISTINA (RN)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:CHRISTINA
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8728 S FIR AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90002-1514
Mailing Address - Country:US
Mailing Address - Phone:323-253-6754
Mailing Address - Fax:
Practice Address - Street 1:105 S PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1969
Practice Address - Country:US
Practice Address - Phone:131-067-4834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA678868163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse