Provider Demographics
NPI:1518317544
Name:FORSBERG, MEGAN GRACE (AGPCNP-BC, RN)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:GRACE
Last Name:FORSBERG
Suffix:
Gender:F
Credentials:AGPCNP-BC, RN
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:LYNN
Other - Last Name:GRACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1483 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5165
Mailing Address - Country:US
Mailing Address - Phone:830-560-2813
Mailing Address - Fax:830-560-2812
Practice Address - Street 1:1483 E COURT ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5165
Practice Address - Country:US
Practice Address - Phone:830-560-2813
Practice Address - Fax:830-560-2812
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131192363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX543163YLPSMedicare PIN