Healthcare Provider Details

I. General information

NPI: 1982000329
Provider Name (Legal Business Name): FIKIRTA FORRESTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 BALTIMORE AVE
RIVERDALE PARK MD
20737
US

IV. Provider business mailing address

30 G IRONSTONE CT
ANNAPOLIS MD
21403
US

V. Phone/Fax

Practice location:
  • Phone: 301-699-5004
  • Fax:
Mailing address:
  • Phone: 410-268-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR165746
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: