Provider Demographics
NPI:1295285047
Name:FERGUSON, SANDRA N (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:N
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 PHILADELPHIA RD
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-3216
Mailing Address - Country:US
Mailing Address - Phone:443-840-9478
Mailing Address - Fax:410-538-5510
Practice Address - Street 1:1518 PHILADELPHIA RD
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-3216
Practice Address - Country:US
Practice Address - Phone:443-840-9478
Practice Address - Fax:410-538-5510
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR197133363LF0000X
MD2016015572363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD847503200Medicaid