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General NPI Number Information
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NPI Number | 1437201910
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Entity Type | Organization
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Legal Business Name | DONNA L FORNS
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3126 SE LOOP 820
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City | FORT WORTH
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State | TX
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Zip | 76140-1031
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Country | US
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Telephone | 817-551-3733
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Fax | 817-551-3799
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Provider Business Mailing Address
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Address Line | PO BOX 40683
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City | FORT WORTH
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State | TX
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Zip | 76140-0683
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Country | US
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Telephone | 817-551-3733
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Fax | 817-551-3799
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DONNA LEE FORNS
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Credential |
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Telephone | 817-551-3733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 16000
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License Number State | TX
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