NPI | 1639648355 |
---|---|
Former Name | SHANA FERGUSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL APRN11035678) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704272887) |
363LP0200X Nurse Practitioner, Pediatrics (Licence: MI 4704272887) | |
Enumeration Date | 2018-11-26 |
Last Update Date | 2025-05-27 |