Provider Demographics
NPI:1104413848
Name:FERGUSON, FAY NELSIE
Entity type:Individual
Prefix:
First Name:FAY
Middle Name:NELSIE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21414 NEW GEORGES CREEK RD SW
Mailing Address - Street 2:
Mailing Address - City:WESTERNPORT
Mailing Address - State:MD
Mailing Address - Zip Code:21562-3010
Mailing Address - Country:US
Mailing Address - Phone:443-370-8375
Mailing Address - Fax:
Practice Address - Street 1:21414 NEW GEORGES CREEK RD SW
Practice Address - Street 2:
Practice Address - City:WESTERNPORT
Practice Address - State:MD
Practice Address - Zip Code:21562-3010
Practice Address - Country:US
Practice Address - Phone:443-370-8375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant