Healthcare Provider Details

I. General information

NPI: 1134708753
Provider Name (Legal Business Name): DEBBRA LYNN FORRESTER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 SUNSET DR STE F
LA GRANDE OR
97850-1200
US

IV. Provider business mailing address

PO BOX 3290
LA GRANDE OR
97850-7290
US

V. Phone/Fax

Practice location:
  • Phone: 541-663-3100
  • Fax: 541-975-5135
Mailing address:
  • Phone: 541-963-8421
  • Fax: 541-963-1476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202008828NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: