Provider Demographics
NPI:1952910739
Name:FERGUSON, MOLLIE (RD, LDN, IFMCP)
Entity Type:Individual
Prefix:MRS
First Name:MOLLIE
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:RD, LDN, IFMCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46-036 KAMEHAMEHA HWY
Mailing Address - Street 2:P.O. BOX #1505
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744
Mailing Address - Country:US
Mailing Address - Phone:626-470-7711
Mailing Address - Fax:
Practice Address - Street 1:46-036 KAMEHAMEHA HWY
Practice Address - Street 2:P.O. BOX #1505
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744
Practice Address - Country:US
Practice Address - Phone:626-470-7711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered