Provider Demographics
NPI:1194384834
Name:LORNA FORBES NURSE PRACTITIONER IN FAMILY HEALTH PLLC
Entity Type:Organization
Organization Name:LORNA FORBES NURSE PRACTITIONER IN FAMILY HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:CORDELLA
Authorized Official - Last Name:FORBES
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:315-751-7127
Mailing Address - Street 1:8417 HOBNAIL RD
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9332
Mailing Address - Country:US
Mailing Address - Phone:315-420-1546
Mailing Address - Fax:315-315-7485
Practice Address - Street 1:33 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3894
Practice Address - Country:US
Practice Address - Phone:315-751-7127
Practice Address - Fax:315-748-5377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-06
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1477873776Medicaid