Provider Demographics
NPI:1972941672
Name:FERGUSON, SARALYN
Entity Type:Individual
Prefix:MS
First Name:SARALYN
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17550 STANSBURY ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2615
Mailing Address - Country:US
Mailing Address - Phone:313-492-3235
Mailing Address - Fax:313-646-4614
Practice Address - Street 1:17550 STANSBURY ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2615
Practice Address - Country:US
Practice Address - Phone:313-492-3235
Practice Address - Fax:313-646-4614
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704232445363LP0808X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health