Provider Demographics
NPI:1841602794
Name:FERGUSON, JAMES LEWIS (CNP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LEWIS
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 W MEDICAL CENTER DR STE B100
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8438
Mailing Address - Country:US
Mailing Address - Phone:815-344-8585
Mailing Address - Fax:815-344-8610
Practice Address - Street 1:4309 W MEDICAL CENTER DR STE B100
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050
Practice Address - Country:US
Practice Address - Phone:815-344-8585
Practice Address - Fax:815-344-8610
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011623363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209011623OtherSTATE LICENSE