1821088097 NPI number — MRS. CAROL A. FERGUSON RD, CDE

Table of content: MRS. CAROL A. FERGUSON RD, CDE (NPI 1821088097)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821088097 NPI number — MRS. CAROL A. FERGUSON RD, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERGUSON
Provider First Name:
CAROL
Provider Middle Name:
A.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD, CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821088097
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4881 SUGAR MAPLE DR
Provider Second Line Business Mailing Address:
88 MDG/SGQD
Provider Business Mailing Address City Name:
WRIGHT PATTERSON AFB
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45433-5546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-257-0485
Provider Business Mailing Address Fax Number:
937-656-1093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4881 SUGAR MAPLE DR
Provider Second Line Business Practice Location Address:
88 MDG/SGQD
Provider Business Practice Location Address City Name:
WRIGHT PATTERSON AFB
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45433-5546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-257-0485
Provider Business Practice Location Address Fax Number:
937-656-1093
Provider Enumeration Date:
10/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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