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NPI Code Detail

MEDICARE: CONNIE S FORUP RN

MEDICARE: CONNIE S FORUP RN
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
1163WP0808XPsychiatric/Mental Health Registered NurseRN318170OH

General Provider Information

NPI Number : 1467879635
Entity Type Code : Individual
Provider Name (Legal Business Name) : CONNIE S FORUP RN
Provider Business Mailing Address
First Line : 1212 CHERRY ST
Second Line :
City : TOLEDO
State : OH
Zip : 43608-2906
Country : US
Telephone Number : 419-936-7415
Fax Number :
Provider Business Practice Location Address
First Line : 1212 CHERRY ST
Second Line :
City : TOLEDO
State : OH
Zip : 43608-2906
Country : US
Telephone Number : 419-936-7415
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2014
Last Update Date : 02/20/2017

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