Individual
JAVAUNI FORREST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
601 ELMWOOD AVE, ROCHESTER, NY 14642-0001
(646) 853-5307
Mailing address
154 SQUAREVIEW LN, ROCHESTER, NY 14626-1868
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
754334
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
405270
NY
Other
Enumeration date
08/14/2023
Last updated
10/09/2023
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