Provider Demographics
NPI:1639680044
Name:FERGUSON, CLAIRE NICOLE
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:NICOLE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6745 BROOKS LN
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-8913
Mailing Address - Country:US
Mailing Address - Phone:916-206-4491
Mailing Address - Fax:
Practice Address - Street 1:6745 BROOKS LN
Practice Address - Street 2:
Practice Address - City:LOOMIS
Practice Address - State:CA
Practice Address - Zip Code:95650-8913
Practice Address - Country:US
Practice Address - Phone:916-206-4491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program