Provider Demographics
NPI:1720407786
Name:FERGUSON, ANA MARIE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ANA MARIE
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:ANA MARIE
Other - Middle Name:VICTORIA
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:324 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97458
Mailing Address - Country:US
Mailing Address - Phone:541-572-2111
Mailing Address - Fax:541-572-5743
Practice Address - Street 1:324 4TH ST
Practice Address - Street 2:
Practice Address - City:MYRTLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97458
Practice Address - Country:US
Practice Address - Phone:541-572-2111
Practice Address - Fax:541-572-5743
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201400072NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500675277Medicaid
ORR0000WFBTVOtherNORTH BEND MEDICAL CENTER GROUP MEDICARE
OR161133OtherNORTH BEND MEDICAL CENTER GROUP MEDICAID
ORP01805331OtherRAILROAD MEDICARE
OR1407812365OtherNORTH BEND MEDICAL CENTER GROUP NPI
ORR0000WFBTVOtherNORTH BEND MEDICAL CENTER GROUP MEDICARE