Healthcare Provider Details

I. General information

NPI: 1235782087
Provider Name (Legal Business Name): CHARLOTTE FORRESTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 DAVIES DR
WAPPINGERS FALLS NY
12590-4705
US

IV. Provider business mailing address

25 DAVIES DR
WAPPINGERS FALLS NY
12590-4705
US

V. Phone/Fax

Practice location:
  • Phone: 845-392-6531
  • Fax:
Mailing address:
  • Phone: 845-392-6531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number297545-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: