Healthcare Provider Details

I. General information

NPI: 1801990593
Provider Name (Legal Business Name): LYNDI SULLENS FORREST APRN-BC MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N DEKALB ST SUITE B
SHELBY NC
28150-4188
US

IV. Provider business mailing address

520 N DEKALB ST SUITE B
SHELBY NC
28150-4188
US

V. Phone/Fax

Practice location:
  • Phone: 704-484-8001
  • Fax: 704-484-2485
Mailing address:
  • Phone: 704-484-8001
  • Fax: 704-484-2485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number005001017
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: