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General NPI Number Information
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NPI Number | 1487274791
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Entity Type | Organization
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Legal Business Name | FORKELA, LLC
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Dates
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Enumeration Date | 04/17/2020
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Last Update Date | 12/08/2022
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Provider Practice Location Address
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Address Line | 823 N BEAVER ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3140
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Country | US
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Telephone | 928-224-2834
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Fax | 928-240-5809
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Provider Business Mailing Address
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Address Line | 823 N BEAVER ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3140
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Country | US
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Telephone | 928-224-2834
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Fax | 928-240-5809
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | LINDSEY FORSTIE
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Credential |
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Telephone | 928-224-2834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number |
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License Number State |
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