Provider Demographics
NPI:1801990593
Name:FORREST, LYNDI SULLENS (APRN-BC MSN)
Entity type:Individual
Prefix:MRS
First Name:LYNDI
Middle Name:SULLENS
Last Name:FORREST
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Gender:F
Credentials:APRN-BC MSN
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Mailing Address - Street 1:520 N DEKALB ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-4188
Mailing Address - Country:US
Mailing Address - Phone:704-484-8001
Mailing Address - Fax:704-484-2485
Practice Address - Street 1:520 N DEKALB ST
Practice Address - Street 2:SUITE B
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-4188
Practice Address - Country:US
Practice Address - Phone:704-484-8001
Practice Address - Fax:704-484-2485
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2011-11-30
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Provider Licenses
StateLicense IDTaxonomies
NC005001017363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2592621Medicare ID - Type Unspecified
Q67046Medicare UPIN