Provider Demographics
NPI:1770144511
Name:FORSBERG, JANICE CECILIA
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:CECILIA
Last Name:FORSBERG
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:CLAYTON AVENUE ELEMENTARY SCHOOL
Mailing Address - Street 2:209 CLAYTON AVENUE
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850
Mailing Address - Country:US
Mailing Address - Phone:607-757-2274
Mailing Address - Fax:607-757-2372
Practice Address - Street 1:CLAYTON AVENUE ELEMENTARY SCHOOL
Practice Address - Street 2:209 CLAYTON AVENUE
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850
Practice Address - Country:US
Practice Address - Phone:607-757-2274
Practice Address - Fax:607-757-2372
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297546-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6077489473Medicaid