Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0200X | Nurse Practitioner - Pediatrics | 2011030338 | MO |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 53-46053-042 | KS |
NPI | 1033454095 |
---|---|
Provider Name | Sarah Forge |
First Address | Overland Park, KS 66212-5427 |
Second Address | Kansas City, MO 64108-4619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2012 |
Last Update Date | 03/12/2012 |