Provider Demographics
NPI:1780963066
Name:FERGUSON, REBECCA JANE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JANE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 MALL DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1534
Mailing Address - Country:US
Mailing Address - Phone:256-767-2702
Mailing Address - Fax:256-760-1870
Practice Address - Street 1:2908 MALL DRIVE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1534
Practice Address - Country:US
Practice Address - Phone:256-767-2702
Practice Address - Fax:256-760-1870
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-064714363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALB59426Medicare UPIN