Provider Demographics
NPI:1992946610
Name:FORREST, NANCIE E, (LAC)
Entity type:Individual
Prefix:MRS
First Name:NANCIE
Middle Name:E,
Last Name:FORREST
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 WATERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2154
Mailing Address - Country:US
Mailing Address - Phone:631-754-4325
Mailing Address - Fax:
Practice Address - Street 1:137 WATERSIDE AVE
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2154
Practice Address - Country:US
Practice Address - Phone:631-754-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003211171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist