Provider Demographics
NPI:1952700197
Name:FORTE, MAURA THERESA (APRN)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:THERESA
Last Name:FORTE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:40 S MAIN ST
Mailing Address - Street 2:STE 1300
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-5513
Mailing Address - Country:US
Mailing Address - Phone:901-422-7617
Mailing Address - Fax:
Practice Address - Street 1:330 WASHINGTON ST
Practice Address - Street 2:SUITE 510
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2700
Practice Address - Country:US
Practice Address - Phone:860-885-1308
Practice Address - Fax:860-889-1982
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT005755363L00000X
CT5755363LF0000X
NYF338949-1363LF0000X
SC24529363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner