Provider Demographics
NPI:1134364763
Name:FERKINGSTAD, DEBRA ROSE (RN)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ROSE
Last Name:FERKINGSTAD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:ROSE
Other - Last Name:MOATS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7130 FOX ROAD
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425
Mailing Address - Country:US
Mailing Address - Phone:218-821-1137
Mailing Address - Fax:
Practice Address - Street 1:106 4TH AVE N.
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56357
Practice Address - Country:US
Practice Address - Phone:218-998-3778
Practice Address - Fax:218-998-3187
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-128886-3163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse