Provider Demographics
NPI:1861400376
Name:FERGUSON, MARJORIE LEE (NP,CS)
Entity type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:LEE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:NP,CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VA ANN ARBOR HEALTHCARE SYSTEM
Mailing Address - Street 2:2215 FULLER RD
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-769-7100
Mailing Address - Fax:
Practice Address - Street 1:VA FLINT HEALTHCARE SYSTEM
Practice Address - Street 2:G-3267 BEECHER RD
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532
Practice Address - Country:US
Practice Address - Phone:810-720-2913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704236751363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health