Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | R150910 | MD |
NPI | 1255301776 |
---|---|
Provider Name | Mrs. Bridgette Diane Ferguson |
First Address | Upper Marlboro, MD 20772-3681 |
Second Address | Annapolis, MD 21402-1006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 26/02/2020 |