Individual
MRS. JACQUELYN RENE FORSSBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1021 EISENHOWER AVE, GREAT BEND, KS 67530
(620) 792-5437
Mailing address
200 COMMODORE ST, PRATT, KS 67124-2903
(620) 450-1186
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
53-76350-092
KS
Other
Enumeration date
07/31/2014
Last updated
03/26/2021
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