Healthcare Provider Details

I. General information

NPI: 1205122058
Provider Name (Legal Business Name): ABIGAIL M WADSWORTH MS, RD, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 MOUNTAIN VIEW DR STE 101
COLCHESTER VT
05446-8081
US

IV. Provider business mailing address

302 MOUNTAIN VIEW DR STE 101
COLCHESTER VT
05446-8081
US

V. Phone/Fax

Practice location:
  • Phone: 802-999-9207
  • Fax: 802-488-5704
Mailing address:
  • Phone: 802-999-9207
  • Fax: 802-488-5704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number010763-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number074.0069760
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: