Provider Demographics
NPI:1205091105
Name:FERGUSON, MOLLY ROSE (ND, LTM)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:ROSE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:ND, LTM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 30TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5210
Mailing Address - Country:US
Mailing Address - Phone:218-284-1188
Mailing Address - Fax:218-284-1190
Practice Address - Street 1:1904 30TH AVE S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5210
Practice Address - Country:US
Practice Address - Phone:218-284-1188
Practice Address - Fax:218-284-1190
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1022176B00000X
MN1003175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No175F00000XOther Service ProvidersNaturopath