Provider Demographics
NPI:1396855599
Name:FORBES, VIRGINIA L (APRN)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:L
Last Name:FORBES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2338
Mailing Address - Country:US
Mailing Address - Phone:406-375-4823
Mailing Address - Fax:406-375-4846
Practice Address - Street 1:1224 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2338
Practice Address - Country:US
Practice Address - Phone:406-375-4823
Practice Address - Fax:406-375-4846
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN14262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1396855599Medicaid
WA1396855599Medicaid
ID1396855599Medicaid
WA1396855599Medicaid
R10682Medicare UPIN
MT011003087 CFMMedicare PIN