Provider Demographics
NPI:1811221815
Name:WHITE FORREST, MARLENE KAY (EMERGENCY MEDICAL TE)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:KAY
Last Name:WHITE FORREST
Suffix:
Gender:F
Credentials:EMERGENCY MEDICAL TE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SOUTH VISITING EAGLE
Mailing Address - Street 2:SANTEE HEALTH CENTER
Mailing Address - City:NIOBRARA
Mailing Address - State:NE
Mailing Address - Zip Code:60760
Mailing Address - Country:US
Mailing Address - Phone:402-857-2300
Mailing Address - Fax:402-857-2315
Practice Address - Street 1:110 SOUTH VISITING EAGLE
Practice Address - Street 2:SANTEE HEALTH CENTER
Practice Address - City:NIOBRARA
Practice Address - State:NE
Practice Address - Zip Code:60760
Practice Address - Country:US
Practice Address - Phone:402-857-2300
Practice Address - Fax:402-857-2315
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE#7795146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic