Provider Demographics
NPI:1881938900
Name:FERGUSON, STEPHANIE RENNA (NURSE AIDE)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RENNA
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:NURSE AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6498 GOLD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BATTLEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27809
Mailing Address - Country:US
Mailing Address - Phone:252-384-3006
Mailing Address - Fax:
Practice Address - Street 1:6498 GOLD DRIVE
Practice Address - Street 2:
Practice Address - City:BATTLEBORO
Practice Address - State:NC
Practice Address - Zip Code:27809
Practice Address - Country:US
Practice Address - Phone:252-384-3006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC425491374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide