Provider Demographics
NPI:1467879635
Name:FORUP, CONNIE S (RN)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:S
Last Name:FORUP
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:S
Other - Last Name:SLUPECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1212 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2906
Mailing Address - Country:US
Mailing Address - Phone:419-936-7415
Mailing Address - Fax:
Practice Address - Street 1:1212 CHERRY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2906
Practice Address - Country:US
Practice Address - Phone:419-936-7415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN318170163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health