Healthcare Provider Details

I. General information

NPI: 1629015235
Provider Name (Legal Business Name): MS. MARY BILZ
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 ALLEN ST
RUTLAND VT
05701-4560
US

IV. Provider business mailing address

160 ALLEN ST
RUTLAND VT
05701-4560
US

V. Phone/Fax

Practice location:
  • Phone: 802-775-7111
  • Fax: 802-775-7214
Mailing address:
  • Phone: 802-775-7111
  • Fax: 802-775-7214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number074-0000125
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: