Provider Demographics
NPI:1790971513
Name:FERRIS, MICHAEL J (NP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:FERRIS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 CABALLO WAY
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-9706
Mailing Address - Country:US
Mailing Address - Phone:530-345-6875
Mailing Address - Fax:
Practice Address - Street 1:277 COHASSET RD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2242
Practice Address - Country:US
Practice Address - Phone:530-332-6300
Practice Address - Fax:530-342-1663
Is Sole Proprietor?:No
Enumeration Date:2007-09-16
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP17411363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN332585OtherRN
CANP17411OtherNP