Provider Demographics
NPI:1407914070
Name:FORSHAG, TERESA LYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:FORSHAG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 N VERCLER RD
Mailing Address - Street 2:BUILDING 1
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1092
Mailing Address - Country:US
Mailing Address - Phone:509-928-6383
Mailing Address - Fax:509-926-9420
Practice Address - Street 1:1414 N VERCLER
Practice Address - Street 2:BUILDING 1
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1092
Practice Address - Country:US
Practice Address - Phone:509-928-6383
Practice Address - Fax:509-926-9420
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004567363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1009711Medicaid