Provider Demographics
NPI:1821785064
Name:FERGUSON, TAMIE (RN)
Entity Type:Individual
Prefix:
First Name:TAMIE
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2643 PATTERSON RD STE 403
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-1937
Mailing Address - Country:US
Mailing Address - Phone:970-298-7672
Mailing Address - Fax:
Practice Address - Street 1:2657 SUMMER VALE CIR UNIT B
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8539
Practice Address - Country:US
Practice Address - Phone:435-260-1794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0120945163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management