Healthcare Provider Details

I. General information

NPI: 1083324354
Provider Name (Legal Business Name): NICOLE FORLAN WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 N CHURCH ST
GREENSBORO NC
27401-1007
US

IV. Provider business mailing address

437 CROSS COUNTRY WAY
DURHAM NC
27703-0417
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-6500
  • Fax:
Mailing address:
  • Phone: 562-787-4412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number5017224
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: