Provider Demographics
NPI:1194163907
Name:FERGUSON, VALERIE NICOLE (NP)
Entity type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:NICOLE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 S BERETANIA ST STE 501
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1301
Mailing Address - Country:US
Mailing Address - Phone:808-949-3444
Mailing Address - Fax:808-949-7808
Practice Address - Street 1:1907 S BERETANIA ST STE 501
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1301
Practice Address - Country:US
Practice Address - Phone:808-949-3444
Practice Address - Fax:808-949-7870
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21396363LF0000X
HIAPRN- 2068363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily