Basic Information
| Provider Information | |||||||||
| NPI: | 1972759777 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FORSTHOFF | ||||||||
| FirstName: | JORDAN | ||||||||
| MiddleName: | MARCUS | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 435 HEYMANN BLVD | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705032616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372343344 | ||||||||
| FaxNumber: | 3372343352 | ||||||||
| Practice Location | |||||||||
| Address1: | 435 HEYMANN BLVD | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705032616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372343344 | ||||||||
| FaxNumber: | 3372343352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2008 | ||||||||
| LastUpdateDate: | 03/21/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | AP05418 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.