Provider Demographics
NPI:1962475673
Name:FERGUSON, ZOLA MYRTLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ZOLA
Middle Name:MYRTLE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3986 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-9741
Mailing Address - Country:US
Mailing Address - Phone:775-544-2621
Mailing Address - Fax:
Practice Address - Street 1:3986 MAPLE LN
Practice Address - Street 2:
Practice Address - City:LOOMIS
Practice Address - State:CA
Practice Address - Zip Code:95650-9741
Practice Address - Country:US
Practice Address - Phone:775-544-2621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-12
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA23049363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical