Provider Demographics
NPI:1699843425
Name:FORTI, DONNA L (LIC AC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:FORTI
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 GEORGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01519-1416
Mailing Address - Country:US
Mailing Address - Phone:508-839-0415
Mailing Address - Fax:
Practice Address - Street 1:107 GRAFTON HILL ROAD
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01519
Practice Address - Country:US
Practice Address - Phone:508-839-0415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist