Healthcare Provider Details

I. General information

NPI: 1770919995
Provider Name (Legal Business Name): DONNA MICHELE FORSEE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 10/25/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 CORPORATE PARK DR STE 200&300
MOORESVILLE NC
28117-7134
US

IV. Provider business mailing address

19485 OLD JETTON RD SUITE 100
CORNELIUS NC
28031-6582
US

V. Phone/Fax

Practice location:
  • Phone: 704-235-9090
  • Fax: 704-235-9101
Mailing address:
  • Phone: 704-384-1775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-04514
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-04514
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: