Provider Demographics
NPI:1649275033
Name:R, SUSAN FERGUSON (NP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:FERGUSON
Last Name:R
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 OLENTANGY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1552
Mailing Address - Country:US
Mailing Address - Phone:614-268-8800
Mailing Address - Fax:614-268-8249
Practice Address - Street 1:3045 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43202-1552
Practice Address - Country:US
Practice Address - Phone:614-268-8800
Practice Address - Fax:614-268-8249
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP02429363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNP02429OtherMEDICAL LICENSE
OH2154994Medicaid
OHNP02429OtherMEDICAL LICENSE
OHP13271Medicare UPIN