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MR. DEMETRIUS LAVAL FORTE SR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LPN

Contact information

Practice address
9040 JACKSON AVENUE, ATTN MCHJ-CLQ-C, TACOMA, WA 98431-1000
(253) 968-1110
(253) 967-2639
Mailing address
9040 JACKSON AVENUE, ATTN MCHJ-CLQ-C, MADIGAN ARMY MEDICAL CENTER, TACOMA, WA 98431-1000
(253) 967-2639

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
00055722
WA

Other

Enumeration date
05/03/2016
Last updated
05/03/2016
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