Individual
CHARLOTTE FORKUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 W 10TH ST, TN DEPT OF HEALTH, COOKEVILLE, TN 38501-6077
(931) 528-7531
(931) 520-0413
Mailing address
5500 WHITTAKER RD, COOKEVILLE, TN 38506-7022
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
42380
TN
Other
Enumeration date
03/01/2007
Last updated
07/08/2007
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