Healthcare Provider Details

I. General information

NPI: 1467503599
Provider Name (Legal Business Name): CARRIE L RANCOURT RD, LD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 CORLISS LN
COLEBROOK NH
03576-3207
US

IV. Provider business mailing address

151 OLD COUNTRY RD
CLARKSVILLE NH
03592-7214
US

V. Phone/Fax

Practice location:
  • Phone: 603-237-4971
  • Fax:
Mailing address:
  • Phone: 603-246-3490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number142
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: