Individual
CARRIE FORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 E LANCASTER AVE, WYNNEWOOD, PA 19096-3450
(484) 476-6840
Mailing address
100 E LANCASTER AVE, WYNNEWOOD, PA 19096-3450
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
MT235307
PA
Other
Enumeration date
06/16/2025
Last updated
06/16/2025
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