Provider Demographics
NPI:1649437617
Name:FERGUSON, ERIN K (NP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:K
Last Name:FERGUSON
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 1:4444 N 32ND ST
Mailing Address - Street 2:SUITE 175
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3956
Mailing Address - Country:US
Mailing Address - Phone:602-952-0002
Mailing Address - Fax:602-778-4565
Practice Address - Street 1:4444 N 32ND ST
Practice Address - Street 2:SUITE 175
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3956
Practice Address - Country:US
Practice Address - Phone:602-952-0002
Practice Address - Fax:602-778-4565
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN115235363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN115235OtherRN LICENSE