Individual
CYNTHIA FORNESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
243 BAYARD STREET BOX 724, PORT EWEN, NY 12466-0724
(646) 249-5767
Mailing address
PO BOX 724, PORT EWEN, NY 12466-0724
(646) 249-5767
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
248508
NY
Other
Enumeration date
08/31/2016
Last updated
08/31/2016
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