Doctor Name: | MRS. JACQUELYN RENE FORSSBERG |
NPI Number: | 1043628233 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | 53-76350-092 |
Business Practice Address: | 1021 Eisenhower Ave Great Bend, KS - 67530 |
Business Phone Number: | 6207925437 |
Business Fax Number: | |
Mailing Address: | 592 Terrace Dr, PRATT |
State: | KS |
Postal Code: | 671243213 |
Phone Number: | 9139085225 |
Fax Number: | |
NPI Enumeration Date: | 07/31/2014 |
NPI Last Update Date: | 07/31/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | 53-76350-092 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |