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NPI Code Detail

MEDICARE: STEFANIE NANETTE FORRESTER PAC

MEDICARE: STEFANIE NANETTE FORRESTER PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA22003CA
2363AM0700XMedical Physician AssistantPA5503OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA5503OTHEROKOKLAHOMA PA LICENSE
2PA22003OTHERCACALIFORNIA PA LICENSE

General Provider Information

NPI Number : 1366719080
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEFANIE NANETTE FORRESTER PAC
Provider Business Mailing Address
First Line : 4913 W RENO AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73127-6339
Country : US
Telephone Number : 405-948-4900
Fax Number : 405-948-4933
Provider Business Practice Location Address
First Line : 309 S ANN ARBOR AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73128-1112
Country : US
Telephone Number : 405-948-4900
Fax Number : 405-948-4933
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2011
Last Update Date : 12/26/2024

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1962667592 — DR. AMANDA LYN THOMAS MD
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1033653019 — HOAI NGUYEN PA-C
Practice Location Address:
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73128-1112
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Directions to “ STEFANIE NANETTE FORRESTER PAC” Practice Location

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