Healthcare Provider Details

I. General information

NPI: 1477646180
Provider Name (Legal Business Name): FORREST O'NEAL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4780 SOUTH GRAND STREET
MONROE LA
71202
US

IV. Provider business mailing address

516 SPENCER STREET APT.3
RAYVILLE LA
71269
US

V. Phone/Fax

Practice location:
  • Phone: 318-362-5430
  • Fax:
Mailing address:
  • Phone: 318-245-1185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License NumberRN065624
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: