Provider Demographics
NPI:1356111462
Name:FERGUSON, MARJORIE MAE (LPN)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:MAE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:MAE
Other - Last Name:PIPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01302-0265
Mailing Address - Country:US
Mailing Address - Phone:508-344-8958
Mailing Address - Fax:
Practice Address - Street 1:20 PRATT ST
Practice Address - Street 2:
Practice Address - City:ERVING
Practice Address - State:MA
Practice Address - Zip Code:01344-4407
Practice Address - Country:US
Practice Address - Phone:508-344-8958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN87718164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse