Individual
AMANDA RAE FORRISTAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8035
Mailing address
300 EAST HOSPITAL ROAD, FORT GORDON, GA 30905
(706) 787-3835
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
4704243857
MI
Other
Enumeration date
02/05/2007
Last updated
12/11/2018
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