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General NPI Number Information
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NPI Number | 1831459387
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Entity Type | Individual
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Provider Name | ANNE LOGAN FORSYTH BASS FNP
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Gender | Female
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Dates
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Enumeration Date | 05/17/2012
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Last Update Date | 05/17/2012
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Provider Practice Location Address
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Address Line | 2207 PETERS CREEK RD NW
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City | ROANOKE
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State | VA
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Zip | 24017-1618
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Country | US
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Telephone | 540-562-3457
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Fax |
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Provider Business Mailing Address
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Address Line | 209 PARKCREST ST SW
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City | ROANOKE
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State | VA
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Zip | 24014-4211
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Country | US
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Telephone |
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024167950
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License Number State | VA
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