Provider Demographics
NPI:1972668879
Name:FERGUSON, CYNTHIA TARA (PHD CNM MSN MPH)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:TARA
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:PHD CNM MSN MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 MIDDLETON MILLS LN
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:VA
Mailing Address - Zip Code:22963-5250
Mailing Address - Country:US
Mailing Address - Phone:301-801-6661
Mailing Address - Fax:
Practice Address - Street 1:180 MIDDLETON MILLS LN
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:VA
Practice Address - Zip Code:22963-5250
Practice Address - Country:US
Practice Address - Phone:301-801-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2015-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR166099163W00000X, 367A00000X
VA0017142578367A00000X
VA0024128984367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse