Provider Demographics
NPI:1427077437
Name:FORREST, FELICIA (CNM, ARNP)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:FORREST
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19716 11TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-2617
Mailing Address - Country:US
Mailing Address - Phone:206-533-2314
Mailing Address - Fax:425-778-3866
Practice Address - Street 1:19505 76TH AVE W
Practice Address - Street 2:SUITE 200
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5011
Practice Address - Country:US
Practice Address - Phone:425-771-7450
Practice Address - Fax:425-778-3866
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00143469163W00000X
WAAP30006810363L00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9643735Medicaid
WA8852299Medicare PIN
WA9643735Medicaid