Provider Demographics
NPI:1417566175
Name:FORRESTER, SANDRA
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:FORRESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1589 GENTRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL BLOOMERY
Mailing Address - State:TN
Mailing Address - Zip Code:37680-4209
Mailing Address - Country:US
Mailing Address - Phone:423-727-1553
Mailing Address - Fax:
Practice Address - Street 1:1589 GENTRY CREEK RD
Practice Address - Street 2:
Practice Address - City:LAUREL BLOOMERY
Practice Address - State:TN
Practice Address - Zip Code:37680-4209
Practice Address - Country:US
Practice Address - Phone:423-727-1553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider