Provider Demographics
NPI:1568796753
Name:FORREST, ERIN LYNN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LYNN
Last Name:FORREST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 TIJERAS AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4633
Mailing Address - Country:US
Mailing Address - Phone:505-231-0014
Mailing Address - Fax:
Practice Address - Street 1:1408 TIJERAS AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4633
Practice Address - Country:US
Practice Address - Phone:505-231-0014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator