Provider Demographics
NPI:1821788142
Name:FERGUSON, LAQUANTE OSCAR
Entity Type:Individual
Prefix:
First Name:LAQUANTE
Middle Name:OSCAR
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1383 E MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48529-2059
Mailing Address - Country:US
Mailing Address - Phone:810-964-0412
Mailing Address - Fax:
Practice Address - Street 1:1383 E MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48529-2059
Practice Address - Country:US
Practice Address - Phone:810-964-0412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker