Doctor Name: | AMY FERGUSON |
NPI Number: | 1295191880 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 551221-1 |
Business Practice Address: | 9001 Old River Road Marcy, NY - 134030216 |
Business Phone Number: | 3157688581 |
Business Fax Number: | 3157688595 |
Mailing Address: | Po Box 216, River Road MARCY |
State: | NY |
Postal Code: | 134030216 |
Phone Number: | 3157688581 |
Fax Number: | 3157688595 |
NPI Enumeration Date: | 01/12/2016 |
NPI Last Update Date: | 01/12/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 551221-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |