Healthcare Provider Details

I. General information

NPI: 1497791271
Provider Name (Legal Business Name): RACHEL J FORBERG F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL J BUNT F.N.P.

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 BUFFALO RD STE 1
NORTH CHILI NY
14514-1256
US

IV. Provider business mailing address

PO BOX 505
NORTH CHILI NY
14514-0505
US

V. Phone/Fax

Practice location:
  • Phone: 585-594-5995
  • Fax: 585-594-5425
Mailing address:
  • Phone: 585-594-5995
  • Fax: 585-594-5425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF332225-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number433456-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: