Provider Demographics
NPI:1477873776
Name:FORBES, LORNA CORDELLA (FNP)
Entity type:Individual
Prefix:
First Name:LORNA
Middle Name:CORDELLA
Last Name:FORBES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8417 HOBNAIL RD
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9332
Mailing Address - Country:US
Mailing Address - Phone:315-420-1546
Mailing Address - Fax:
Practice Address - Street 1:620 ERIE BLVD W STE 208
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204
Practice Address - Country:US
Practice Address - Phone:315-472-7363
Practice Address - Fax:315-701-2368
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY467404-1163W00000X
NYF336363363LF0000X
NY402451363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400030541Medicare PIN