Provider Demographics
NPI:1760510440
Name:FERGUSON, REBECCA L (CFNP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:L
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2329 N DIRKSEN PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-1403
Mailing Address - Country:US
Mailing Address - Phone:217-789-1403
Mailing Address - Fax:217-789-1825
Practice Address - Street 1:800 E CARPENTER
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62769-0001
Practice Address - Country:US
Practice Address - Phone:217-544-6464
Practice Address - Fax:217-757-6812
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322591363L00000X
IL209-004743363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid
IL$$$$$$$$$001Medicaid
Q00126Medicare UPIN
ILK47127Medicare PIN