Provider Demographics
NPI:1649565334
Name:FOGARTY, KRISTA HOLLINSHEAD (RD)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:HOLLINSHEAD
Last Name:FOGARTY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:WELLS
Other - Last Name:HOLLINSHEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:365 MONTAUK AVENUE
Mailing Address - Street 2:LAWRENCE AND MEMORIAL HOSPITAL FOOD AND NUTRITION DEPT
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4769
Mailing Address - Country:US
Mailing Address - Phone:860-442-0711
Mailing Address - Fax:
Practice Address - Street 1:365 MONTAUK AVE
Practice Address - Street 2:LAWRENCE AND MEMORIAL HOSPITAL FOOD AND NUTRITION DEPT
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4700
Practice Address - Country:US
Practice Address - Phone:860-442-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000652133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered