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General NPI Number Information
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NPI Number | 1053263764
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Entity Type | Organization
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Legal Business Name | FORWARD HEALTHY LIFESTYLES
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Dates
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Enumeration Date | 02/13/2026
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 145 W WISCONSIN AVE UNIT 3
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City | PEWAUKEE
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State | WI
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Zip | 53072-3437
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Country | US
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Telephone | 262-313-8375
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Fax |
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Provider Business Mailing Address
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Address Line | N112W15237 MEQUON RD STE 100
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City | GERMANTOWN
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State | WI
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Zip | 53022-3466
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Country | US
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Telephone | 262-313-8375
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Fax |
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Authorized Official
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Title or Position | APNP
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Name | LINDSAY A CARMODY
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Credential | APNP
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Telephone | 262-313-8375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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