Provider Demographics
NPI:1295232924
Name:FERGUSON, MONDE MWIYA (FNP)
Entity type:Individual
Prefix:MRS
First Name:MONDE
Middle Name:MWIYA
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 POPLAR POINT DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-9276
Mailing Address - Country:US
Mailing Address - Phone:214-542-1907
Mailing Address - Fax:
Practice Address - Street 1:3919 POPLAR POINT DR
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-9276
Practice Address - Country:US
Practice Address - Phone:214-542-1907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily