Healthcare Provider Details

I. General information

NPI: 1730178773
Provider Name (Legal Business Name): DEBORAH COFIELD FORREST N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MEMORIAL DR SUITE B
LURAY VA
22835-1000
US

IV. Provider business mailing address

323 ALMOND DR
LURAY VA
22835-3520
US

V. Phone/Fax

Practice location:
  • Phone: 540-743-9087
  • Fax:
Mailing address:
  • Phone: 540-743-6517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024158166
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: