Individual
PHEDRA L FORIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3075 ORCHARD VISTA DR SE, GRAND RAPIDS, MI 49546-7069
(616) 262-2074
Mailing address
3075 ORCHARD VISTA DR SE, GRAND RAPIDS, MI 49546-7069
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703094449
MI
164X00000X
Licensed Vocational Nurse
4703094449
MI
Other
Enumeration date
07/28/2020
Last updated
07/30/2020
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