Provider Demographics
NPI:1659631497
Name:KANE FERGUSON, ANN MARGARET (RD)
Entity Type:Individual
Prefix:MS
First Name:ANN MARGARET
Middle Name:
Last Name:KANE FERGUSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 DELTONA DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2738
Mailing Address - Country:US
Mailing Address - Phone:973-534-9030
Mailing Address - Fax:
Practice Address - Street 1:3100 DURALEIGH RD STE 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8104
Practice Address - Country:US
Practice Address - Phone:984-215-4570
Practice Address - Fax:984-215-4571
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-28
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2721133V00000X
NCL002796133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered