Provider Demographics
NPI:1235939679
Name:FERGUSON-MACIAS, COURTNEY VERGETTA
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:VERGETTA
Last Name:FERGUSON-MACIAS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S BELTLINE HWY E STE B
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-3510
Mailing Address - Country:US
Mailing Address - Phone:308-225-2306
Mailing Address - Fax:
Practice Address - Street 1:615 S BELTLINE HWY E STE B
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-3510
Practice Address - Country:US
Practice Address - Phone:308-225-2306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor