MEDICARE: RACHEL J FORBERG F.N.P.

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	163W00000X	Registered Nurse	433456-1	NY
2	363LF0000X	Family Nurse Practitioner	F332225-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	005605372	OTHER	NY	HEALTHNOW BSWNY BRCKPRT
2	019332225	OTHER	NY	EXCELLUS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	109371BF	OTHER	NY	PREFERRED CARE

General Provider Information

NPI Number	:	1497791271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL J FORBERG F.N.P.

Provider Business Mailing Address
First Line	:	PO BOX 505
Second Line	:
City	:	NORTH CHILI
State	:	NY
Zip	:	14514-0505
Country	:	US
Telephone Number	:	585-594-5995
Fax Number	:	585-594-5425

Provider Business Practice Location Address
First Line	:	4201 BUFFALO RD STE 1
Second Line	:
City	:	NORTH CHILI
State	:	NY
Zip	:	14514-1256
Country	:	US
Telephone Number	:	585-594-5995
Fax Number	:	585-594-5425

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	03/01/2019

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