MEDICARE: MORGAN RAINVILLE RDN, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	074.0109160	VT

General Provider Information

NPI Number	:	1619654944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN RAINVILLE RDN, LD

Provider Business Mailing Address
First Line	:	12 JONATHAN AVE
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-7330
Country	:	US
Telephone Number	:	513-702-6698
Fax Number	:

Provider Business Practice Location Address
First Line	:	142 W TWIN OAKS TER
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-7132
Country	:	US
Telephone Number	:	802-658-0001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2023
Last Update Date	:	06/29/2023

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