Provider Demographics
NPI:1871954354
Name:FERGUSON, CATHY (LPN)
Entity type:Individual
Prefix:
First Name:CATHY
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 1:6301 TWITCHELL RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-9274
Mailing Address - Country:US
Mailing Address - Phone:937-342-8810
Mailing Address - Fax:
Practice Address - Street 1:6301 TWITCHELL RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-9274
Practice Address - Country:US
Practice Address - Phone:937-342-8810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 074278164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse