Provider Demographics
NPI:1932154366
Name:FERGUSON, MONICA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:HOLCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 945
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-0103
Mailing Address - Country:US
Mailing Address - Phone:503-344-6717
Mailing Address - Fax:503-345-9867
Practice Address - Street 1:511 MAIN ST
Practice Address - Street 2:SUITE 112
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1830
Practice Address - Country:US
Practice Address - Phone:503-344-6717
Practice Address - Fax:503-345-9867
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200650008NP363LF0000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR243056Medicaid
OR1336596113OtherNPI AT HOME PROIMARY CARE
OR462059907OtherFEDERAL
OR500678021Medicaid
OR1093053431OtherHOUSECALL MEDICAL SERVICES, INC NPI
OR1932154366OtherNPI
ORR178969OtherMEDICARE ID INDIV HMS
ORR178970OtherMEDICARE ID HMS
OR1093053431OtherHOUSECALL MEDICAL SERVICES, INC NPI
ORR178970OtherMEDICARE ID HMS