Provider Demographics
NPI:1952637043
Name:FERGUSON, TEALE MAUREEN (LPN)
Entity Type:Individual
Prefix:
First Name:TEALE
Middle Name:MAUREEN
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 BARKLEY PL E
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2002
Mailing Address - Country:US
Mailing Address - Phone:614-592-8979
Mailing Address - Fax:
Practice Address - Street 1:244 BARKLEY PL E
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213-2002
Practice Address - Country:US
Practice Address - Phone:614-592-8979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.129857 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse