Healthcare Provider Details

I. General information

NPI: 1558085902
Provider Name (Legal Business Name): CHAMPLAIN NUTRITION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 MAIN STREET
VERGENNES VT
05491-0000
US

IV. Provider business mailing address

64 MAIN STREET
VERGENNES VT
05491-0000
US

V. Phone/Fax

Practice location:
  • Phone: 802-989-1942
  • Fax: 802-419-3715
Mailing address:
  • Phone: 802-989-1942
  • Fax: 802-419-3715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. AMY RICE
Title or Position: MEMBER
Credential: RD
Phone: 802-989-1942