Provider Demographics
NPI:1730178773
Name:FORREST, DEBORAH COFIELD (NP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:COFIELD
Last Name:FORREST
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 ALMOND DR
Mailing Address - Street 2:
Mailing Address - City:LURAY
Mailing Address - State:VA
Mailing Address - Zip Code:22835-3520
Mailing Address - Country:US
Mailing Address - Phone:540-743-6517
Mailing Address - Fax:
Practice Address - Street 1:250 MEMORIAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:LURAY
Practice Address - State:VA
Practice Address - Zip Code:22835-1000
Practice Address - Country:US
Practice Address - Phone:540-743-9087
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024158166363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0077899459Medicaid
VAP88728Medicare UPIN