Healthcare Provider Details

I. General information

NPI: 1659332617
Provider Name (Legal Business Name): JEAN M FORTI R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 W WALTERS DR
GRAFTON WI
53024-2243
US

IV. Provider business mailing address

141 W WALTERS DR
GRAFTON WI
53024-2243
US

V. Phone/Fax

Practice location:
  • Phone: 262-375-2474
  • Fax:
Mailing address:
  • Phone: 262-375-2474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number83589-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: