Provider Demographics
NPI:1467950204
Name:FORSMARK, TAYLOR (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:FORSMARK
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:HAMLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:385 SUNSET SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89441-5561
Mailing Address - Country:US
Mailing Address - Phone:775-737-1712
Mailing Address - Fax:
Practice Address - Street 1:625 INNOVATION DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2215
Practice Address - Country:US
Practice Address - Phone:775-799-7360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV40309-DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered