Provider Demographics
NPI:1568020691
Name:FORBES WELLNESS LLC
Entity Type:Organization
Organization Name:FORBES WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:E
Authorized Official - Last Name:FORBES
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:703-690-8482
Mailing Address - Street 1:PO BOX 828
Mailing Address - Street 2:
Mailing Address - City:OCCOQUAN
Mailing Address - State:VA
Mailing Address - Zip Code:22125-0828
Mailing Address - Country:US
Mailing Address - Phone:703-690-8482
Mailing Address - Fax:
Practice Address - Street 1:9107 OAK CHASE CT
Practice Address - Street 2:
Practice Address - City:FAIRFAX STATION
Practice Address - State:VA
Practice Address - Zip Code:22039-3333
Practice Address - Country:US
Practice Address - Phone:703-690-8482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty