Provider Demographics
NPI:1427018803
Name:FORRESTER, MARILYN (CRNA)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:FORRESTER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-9284
Mailing Address - Country:US
Mailing Address - Phone:304-264-8933
Mailing Address - Fax:304-264-8846
Practice Address - Street 1:94 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-9284
Practice Address - Country:US
Practice Address - Phone:304-264-8933
Practice Address - Fax:304-264-8846
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV34596207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0068662000Medicaid
WV0068662000Medicaid