Provider Demographics
NPI:1275519746
Name:FORGETTE, SALLY (ARNP)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:FORGETTE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:FORGETTE-DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:21616 76TH AVE W
Mailing Address - Street 2:#205
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7512
Mailing Address - Country:US
Mailing Address - Phone:425-640-4810
Mailing Address - Fax:425-640-4998
Practice Address - Street 1:21616 76TH AVE W
Practice Address - Street 2:#205
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7512
Practice Address - Country:US
Practice Address - Phone:425-640-4810
Practice Address - Fax:425-640-4998
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000673363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9609256Medicaid
WAS45840Medicare UPIN
WAAB02354Medicare ID - Type Unspecified