Healthcare Provider Details

I. General information

NPI: 1497864565
Provider Name (Legal Business Name): ALISON SWANSON PRECOURT RD,CD,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE NUTRITION SERVICES
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

240 WINTER HAVEN RD
SHELBURNE VT
05482-6551
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-5646
  • Fax: 802-847-2790
Mailing address:
  • Phone: 802-985-8606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number074-0000072
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: