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General NPI Number Information
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NPI Number | 1558085902
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Entity Type | Organization
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Legal Business Name | CHAMPLAIN NUTRITION SERVICES LLC
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Dates
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Enumeration Date | 09/29/2022
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Last Update Date | 09/29/2022
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Provider Practice Location Address
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Address Line | 64 MAIN STREET
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City | VERGENNES
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State | VT
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Zip | 05491-0000
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Country | US
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Telephone | 802-989-1942
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Fax | 802-419-3715
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Provider Business Mailing Address
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Address Line | 64 MAIN STREET
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City | VERGENNES
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State | VT
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Zip | 05491-0000
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Country | US
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Telephone | 802-989-1942
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Fax | 802-419-3715
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Authorized Official
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Title or Position | MEMBER
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Name | MRS. AMY RICE
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Credential | RD
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Telephone | 802-989-1942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State | NULL
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