De Leon Ferguson, Rae Jean

De Leon Ferguson, Rae Jean is an individual health care provider with primary practice located at 24743 W Illini St , Buckeye AZ 85326-3376. She recently has only one registered license in Other Service Providers / Contractor, which is considered as her primary health care specialty. De Leon Ferguson, Rae Jean can be contacted via phone (623) 386-7631.

Contact Information

Primary practice address
24743 W Illini St Buckeye AZ 85326-3376
Phone: (623) 386-7631
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Contractor 171W00000X 11264 Arizona

Profile Details

NPI number 1154477123
LBN Legal business name De Leon Ferguson, Rae Jean
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 25th, 2007
Last updated Oct 13th, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154477123 NPPES
Arizona MEDICAID 171W00000X

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