Basic Information
| Provider Information | |||||||||
| NPI: | 1023375102 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERGUSON | ||||||||
| FirstName: | GUINEVERE | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9293 STATE ROUTE 43 | ||||||||
| Address2: | SUITE B | ||||||||
| City: | STREETSBORO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442415374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306261113 | ||||||||
| FaxNumber: | 3306261133 | ||||||||
| Practice Location | |||||||||
| Address1: | 9293 STATE ROUTE 43 | ||||||||
| Address2: | SUITE B | ||||||||
| City: | STREETSBORO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442415374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306261113 | ||||||||
| FaxNumber: | 3306261133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2012 | ||||||||
| LastUpdateDate: | 08/06/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN247694CDA1 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.