Individual
STACEY THERECIA FORBES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
707 E MAIN ST, MIDDLETOWN, NY 10940-2650
(800) 893-9698
Mailing address
200 CORPORATE BLVD, SUITE 201, LAFAYETTE, LA 70508-3870
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
336988
NY
Other
Enumeration date
12/08/2011
Last updated
12/08/2011
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