Provider Demographics
NPI:1174584247
Name:SHIMBERG, CAROL S (RD)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:S
Last Name:SHIMBERG
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 1:605 OLDE COVINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-9336
Mailing Address - Country:US
Mailing Address - Phone:828-329-3855
Mailing Address - Fax:828-298-5983
Practice Address - Street 1:605 OLDE COVINGTON WAY
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-9336
Practice Address - Country:US
Practice Address - Phone:828-329-3855
Practice Address - Fax:828-298-5983
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC712658133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered