Provider Demographics
NPI:1588481493
Name:FORYSTEK, HEATHER LOUISE (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LOUISE
Last Name:FORYSTEK
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7910 QUAIL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-8986
Mailing Address - Country:US
Mailing Address - Phone:419-490-8408
Mailing Address - Fax:
Practice Address - Street 1:2230 W LASKEY RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-3543
Practice Address - Country:US
Practice Address - Phone:419-517-8858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0037274207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine