Provider Demographics
NPI:1699015891
Name:FORNSHELL, CAROLINE (RD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:FORNSHELL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4680-18I MONTICELLO AVE
Mailing Address - Street 2:#102
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188
Mailing Address - Country:US
Mailing Address - Phone:757-585-3441
Mailing Address - Fax:
Practice Address - Street 1:109 BARROWS MT
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-1403
Practice Address - Country:US
Practice Address - Phone:757-585-3441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered