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Individual
AMANDA H FERGUSON-MACY
Active
Individual
AMANDA H FERGUSON-MACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NNP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28153028A
IN
363LN0005X
Critical Care Neonatal Nurse Practitioner
Primary
71002781A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000610507
ANTHEM PROVIDER NUMBER
IN
05
—
200936930
—
IN
Enumeration date
10/03/2008
Last updated
11/17/2009
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