Provider Demographics
NPI:1174151658
Name:FERGUSON, SAMANTHA RUTH (MSN, CPNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RUTH
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MSN, CPNP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 986513
Mailing Address - Street 2:DEPARTMENT 100
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02298-6513
Mailing Address - Country:US
Mailing Address - Phone:910-219-8326
Mailing Address - Fax:910-939-4269
Practice Address - Street 1:108 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:SNEADS FERRY
Practice Address - State:NC
Practice Address - Zip Code:28460-9415
Practice Address - Country:US
Practice Address - Phone:910-327-5437
Practice Address - Fax:910-327-5436
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2020-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC5013039363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics