Basic Information
| Provider Information | |||||||||
| NPI: | 1215273040 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERGUSON | ||||||||
| FirstName: | IRIS | ||||||||
| MiddleName: | MARION CARLINE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN, RNFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25226 JUSTICE DR | ||||||||
| Address2: | |||||||||
| City: | SOUTH RIDING | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201526011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142272457 | ||||||||
| FaxNumber: | 2147640880 | ||||||||
| Practice Location | |||||||||
| Address1: | 24440 STONE SPRINGS BLVD | ||||||||
| Address2: | |||||||||
| City: | DULLES | ||||||||
| State: | VA | ||||||||
| PostalCode: | 20166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038617660 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2012 | ||||||||
| LastUpdateDate: | 08/24/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WR0006X | 0001130352 | VA | Y | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant |
No ID Information.