Healthcare Provider Details

I. General information

NPI: 1093968273
Provider Name (Legal Business Name): MICCA LYNN DONOHOO R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICCA LYNN LEMON

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 S PROSPECT ST
BURLINGTON VT
05401-3513
US

IV. Provider business mailing address

822 S PROSPECT ST
BURLINGTON VT
05401-3513
US

V. Phone/Fax

Practice location:
  • Phone: 802-222-6907
  • Fax:
Mailing address:
  • Phone: 800-577-5368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164003788
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: