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Individual
STACY J PELLETIER
Active
Individual
STACY J PELLETIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.
Taxonomy
Speciality
Code
Description
License number
State
136A00000X
Registered Dietetic Technician
Primary
074-0000213
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
074-0000213
LICENSE
VT
Enumeration date
10/31/2007
Last updated
10/31/2007
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