Healthcare Provider Details

I. General information

NPI: 1205202231
Provider Name (Legal Business Name): SUSAN FOREST LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 DONS WAY
HOT SPRINGS AR
71913-6478
US

IV. Provider business mailing address

125 DONS WAY
HOT SPRINGS AR
71913-6478
US

V. Phone/Fax

Practice location:
  • Phone: 501-624-7111
  • Fax: 501-620-5109
Mailing address:
  • Phone: 501-624-7111
  • Fax: 501-620-5109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL055928
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: