Healthcare Provider Details

I. General information

NPI: 1629597695
Provider Name (Legal Business Name): KRISTIANA M FORSYTH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 12/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 FRIEND ST
LYNN MA
01902-3068
US

IV. Provider business mailing address

60 HARDING ST
NORTH CHELMSFORD MA
01863-1437
US

V. Phone/Fax

Practice location:
  • Phone: 781-715-6608
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number074819-23
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2286726
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: