Healthcare Provider Details

I. General information

NPI: 1063892081
Provider Name (Legal Business Name): ANDREA FORSYTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18229 DUPONT BLVD
GEORGETOWN DE
19947-3127
US

IV. Provider business mailing address

18229 DUPONT BLVD
GEORGETOWN DE
19947-3127
US

V. Phone/Fax

Practice location:
  • Phone: 302-519-1616
  • Fax:
Mailing address:
  • Phone: 302-519-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberLV0000105
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberLV0000105
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: