1275726754 NPI number — MRS. AMANDA WASHBURN FORBUS FNP

Table of content: MRS. AMANDA WASHBURN FORBUS FNP (NPI 1275726754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275726754 NPI number — MRS. AMANDA WASHBURN FORBUS FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORBUS
Provider First Name:
AMANDA
Provider Middle Name:
WASHBURN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WASHBURN
Provider Other First Name:
AMANDA
Provider Other Middle Name:
CHRISTINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275726754
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
160 RUTLEDGE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29403-5821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-792-6906
Provider Business Mailing Address Fax Number:
843-792-1729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
181 CALHOUN ST.
Provider Second Line Business Practice Location Address:
COLLEGE OF CHARLESTON STUDENT HEATLH
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-953-5520
Provider Business Practice Location Address Fax Number:
843-792-1729
Provider Enumeration Date:
08/20/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  3140 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 3140 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)