Provider Demographics
NPI:1871888115
Name:FERGUSON, TANISHA (LPN)
Entity type:Individual
Prefix:MS
First Name:TANISHA
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3814 BAINBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2246
Mailing Address - Country:US
Mailing Address - Phone:216-799-1130
Mailing Address - Fax:
Practice Address - Street 1:3814 BAINBRIDGE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-2246
Practice Address - Country:US
Practice Address - Phone:216-799-1130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-137158 M.I.V164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse