Healthcare Provider Details

I. General information

NPI: 1568020691
Provider Name (Legal Business Name): FORBES WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9107 OAK CHASE CT
FAIRFAX STATION VA
22039-3333
US

IV. Provider business mailing address

PO BOX 828
OCCOQUAN VA
22125-0828
US

V. Phone/Fax

Practice location:
  • Phone: 703-690-8482
  • Fax:
Mailing address:
  • Phone: 703-690-8482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JILL E FORBES
Title or Position: OWNER
Credential: NP
Phone: 703-690-8482