Basic Information
Provider Information
NPI: 1457332462
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FORTE
FirstName: MURIEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 908 NIAGARA FALLS BLVD
Address2: STE. 208
City: N TONAWANDA
State: NY
PostalCode: 141202019
CountryCode: US
TelephoneNumber: 7166923302
FaxNumber: 7166924342
Practice Location
Address1: 621 10TH ST
Address2:  
City: NIAGARA FALLS
State: NY
PostalCode: 143011813
CountryCode: US
TelephoneNumber: 7166923302
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/07/2005
LastUpdateDate: 11/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WD0400X167857NYY Nursing Service ProvidersRegistered NurseDiabetes Educator

No ID Information.


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