Provider Demographics
NPI:1235503376
Name:FERGUSON, LOIS (RN)
Entity type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 INDIANA WAY NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-2022
Mailing Address - Country:US
Mailing Address - Phone:330-361-1376
Mailing Address - Fax:
Practice Address - Street 1:2318 INDIANA WAY NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44705-2022
Practice Address - Country:US
Practice Address - Phone:330-361-1376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-29
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH422306163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse