| NPI | 1619442803 |
|---|---|
| Former Name | SAMANTHA JO FERGUSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IA A136122) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G136122) |
| Enumeration Date | 2018-10-04 |
| Last Update Date | 2020-12-01 |