Provider Demographics
NPI:1497791271
Name:FORBERG, RACHEL J (FNP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:J
Last Name:FORBERG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:J
Other - Last Name:BUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 505
Mailing Address - Street 2:
Mailing Address - City:NORTH CHILI
Mailing Address - State:NY
Mailing Address - Zip Code:14514-0505
Mailing Address - Country:US
Mailing Address - Phone:585-594-5995
Mailing Address - Fax:585-594-5425
Practice Address - Street 1:4201 BUFFALO RD STE 1
Practice Address - Street 2:
Practice Address - City:NORTH CHILI
Practice Address - State:NY
Practice Address - Zip Code:14514-1256
Practice Address - Country:US
Practice Address - Phone:585-594-5995
Practice Address - Fax:585-594-5425
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY433456-1163W00000X
NYF332225-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005605372OtherHEALTHNOW BSWNY BRCKPRT
NY019332225OtherEXCELLUS
NY02346849Medicaid
NY109371BFOtherPREFERRED CARE
NY109371BFOtherPREFERRED CARE