Provider Demographics
NPI:1033597109
Name:FORKS, LUTHERINE (RN)
Entity Type:Individual
Prefix:
First Name:LUTHERINE
Middle Name:
Last Name:FORKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26335 FIR AVE
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-2211
Mailing Address - Country:US
Mailing Address - Phone:310-462-7387
Mailing Address - Fax:
Practice Address - Street 1:26335 FIR AVE
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-2211
Practice Address - Country:US
Practice Address - Phone:310-462-7387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA396608163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse