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General NPI Number Information
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NPI Number | 1093126641
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Entity Type | Individual
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Provider Name | CARMEN FORGE
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Gender | Female
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Dates
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Enumeration Date | 05/16/2014
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Last Update Date | 05/16/2014
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Provider Practice Location Address
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Address Line | 1343 APPLEGATE DR
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City | LEWISVILLE
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State | TX
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Zip | 75067-3301
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Country | US
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Telephone | 972-891-1429
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Fax | 972-619-8789
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Provider Business Mailing Address
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Address Line | PO BOX 3972
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City | CEDAR HILL
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State | TX
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Zip | 75106-3972
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Country | US
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Telephone | 972-891-1429
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Fax | 972-619-8789
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State | TX
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