Healthcare Provider Details

I. General information

NPI: 1265808208
Provider Name (Legal Business Name): NAJLAH FORREST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4237 HELLERMAN ST
PHILADELPHIA PA
19135-2605
US

IV. Provider business mailing address

4237 HELLERMAN ST
PHILADELPHIA PA
19135-2605
US

V. Phone/Fax

Practice location:
  • Phone: 267-315-1664
  • Fax:
Mailing address:
  • Phone: 267-315-1664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number9905375
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: