Provider Demographics
NPI:1437293909
Name:FORNO, CELIA G (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:CELIA
Middle Name:G
Last Name:FORNO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MS
Other - First Name:CELIA
Other - Middle Name:GRACE
Other - Last Name:FORNO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:770 LYNNHAVEN PKWY
Mailing Address - Street 2:STE 240
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7324
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:603-215-6644
Practice Address - Street 1:5228 NE HOYT ST
Practice Address - Street 2:BLDG B, 2ND FLOOR
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-3055
Practice Address - Country:US
Practice Address - Phone:503-216-2028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2339363LP0808X
OR200950152NP363LP0808X
FLAPRN9398276363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health