Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | R105984-3 | MN |
N | 363LF0000X | Nurse Practitioner - Family Medicine | R105984-3 | MN |
NPI | 1508898156 |
---|---|
Provider Name | Sara Ann Forrest |
First Address | Duluth, MN 55805-1951 |
Second Address | Duluth, MN 55805-1951 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 02/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43903000 | (05) | WI |
828714700 | (05) | MN |
S87601 | (02) |