| Doctor Name: | LAURIE A FORTY |
| NPI Number: | 1003041427 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN, APN-C |
| License Number: | 26NJ00189000 |
| Business Practice Address: | 319 W Landis Ave Vineland, NJ - 083608101 |
| Business Phone Number: | 8564514700 |
| Business Fax Number: | 8564518685 |
| Mailing Address: | 53 S Laurel St, Floor 2 BRIDGETON |
| State: | NJ |
| Postal Code: | 083021946 |
| Phone Number: | 8564514700 |
| Fax Number: | 8564518685 |
| NPI Enumeration Date: | 05/29/2009 |
| NPI Last Update Date: | 02/16/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WG0000X |
| License Number: | 26NJ00189000 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | General Practice |
| Taxonomy Definition: | |