Mrs. Jacquelyn Rene Forssberg
Nurse Practitioner - Pediatrics
1021 Eisenhower Ave
Great Bend
, Kansas 67530
Mrs. Jacquelyn Rene Forssberg
Nurse Practitioner - Pediatrics
1021 Eisenhower Ave
Great Bend
, Kansas 67530
(620) 450-1186
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About
Features
Specialties
- Nurse Practitioner - Pediatrics
Languages spoken
- English
Location
First Address
- Mrs. Jacquelyn Rene Forssberg
- 200 Commodore St
- Pratt, KS
- Zip : 67124-2903
- Phone : (620) 450-1186
Second Address
- Mrs. Jacquelyn Rene Forssberg
- 1021 Eisenhower Ave
- Great Bend, KS
- Zip : 67530
- Phone : (620) 792-5437
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LP0200X | Nurse Practitioner - Pediatrics | 53-76350-092 | KS |
National Provider Identifier
| NPI | 1043628233 |
|---|---|
| Provider Name | Mrs. Jacquelyn Rene Forssberg |
| First Address | Pratt, KS 67124-2903 |
| Second Address | Great Bend, KS 67530 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 31/07/2014 |
| Last Update Date | 26/03/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.