Provider Demographics
NPI:1780346684
Name:FERGUSON, DAWN DARLENE
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:DARLENE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COLL HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-6209
Mailing Address - Country:US
Mailing Address - Phone:845-214-3458
Mailing Address - Fax:
Practice Address - Street 1:88 FOX HOLLOW RD
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-3639
Practice Address - Country:US
Practice Address - Phone:718-206-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204408164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse