MEDICARE: FORENSIC NURSING SPECIALTIES, INC

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
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1407179559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORENSIC NURSING SPECIALTIES, INC

Provider Business Mailing Address
First Line	:	2270 LAKE AVE
Second Line	:	SUITE 201
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-5359
Country	:	US
Telephone Number	:	260-432-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	2270 LAKE AVE
Second Line	:	SUITE 201
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-5359
Country	:	US
Telephone Number	:	260-432-2222
Fax Number	:

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	MS. SHARON ROBISON
Credential	:	RN
Telephone Number	:	260-423-2222

Provider Enumeration Date	:	03/03/2010
Last Update Date	:	03/03/2010

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