Healthcare Provider Details

I. General information

NPI: 1770526733
Provider Name (Legal Business Name): MONICA FORBES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S 17TH ST
CLEAR LAKE IA
50428-2304
US

IV. Provider business mailing address

401 S 17TH ST
CLEAR LAKE IA
50428-2304
US

V. Phone/Fax

Practice location:
  • Phone: 641-357-1800
  • Fax: 641-357-1803
Mailing address:
  • Phone: 641-357-1800
  • Fax: 641-357-1803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number000918
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: