Healthcare Provider Details

I. General information

NPI: 1427179407
Provider Name (Legal Business Name): LINDA K. LASHURE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 GRAND AVE
SWANTON VT
05488-1451
US

IV. Provider business mailing address

55 GRAND AVE.
SWANTON VT
05488-1451
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-3640
  • Fax:
Mailing address:
  • Phone: 802-847-3640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number074-0000051
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: