Provider Demographics
NPI:1992004394
Name:RANKIN-FERGUSON, MAVIS BENITA (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MAVIS
Middle Name:BENITA
Last Name:RANKIN-FERGUSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MAVIS
Other - Middle Name:BENITA
Other - Last Name:RANKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3577 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3577 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1217
Practice Address - Country:US
Practice Address - Phone:313-215-2337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI470419571427163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse