Individual
MISS DETRA FERGUSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11805 W HAMPTON AVE STE 103, MILWAUKEE, WI 53225-3612
(414) 213-3966
(414) 755-7676
Mailing address
11805 W HAMPTON AVE STE 103, MILWAUKEE, WI 53225-3612
(414) 213-3966
(414) 755-7676
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
WI
Other
Enumeration date
04/18/2018
Last updated
04/18/2018
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