Healthcare Provider Details

I. General information

NPI: 1144313784
Provider Name (Legal Business Name): ERIK MARTIN FORBORD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

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

401 WEST GREENLAWN AVENUE
LANSING MI
48910
US

IV. Provider business mailing address

401 WEST GREENLAWN AVENUE
LANSING MI
48910
US

V. Phone/Fax

Practice location:
  • Phone: 517-377-8225
  • Fax: 517-372-5006
Mailing address:
  • Phone: 517-377-8225
  • Fax: 517-372-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704221165
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: