Provider Demographics
NPI:1043053937
Name:FORSLUND, KELSEY DIANE
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:DIANE
Last Name:FORSLUND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23007 MARINE VIEW DR S APT B206
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-8469
Mailing Address - Country:US
Mailing Address - Phone:206-579-3990
Mailing Address - Fax:
Practice Address - Street 1:23007 MARINE VIEW DR S APT B206
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-8469
Practice Address - Country:US
Practice Address - Phone:206-579-3990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00056088164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse