Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | 71763 | NC |
NPI | 1033746011 |
---|---|
Provider Name | Ms. Kelli Ensley Ferguson |
First Address | Bessemer City, NC 28016-9300 |
Second Address | Charlotte, NC 28211-1018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2020 |
Last Update Date | 27/03/2020 |