Individual
MRS. PATRICIA LOGAN MCKIBBEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, CD
Contact information
Practice address
111 COLCHESTER AVE, BURLINGTON, VT 05401-1473
(802) 847-3640
Mailing address
150 DEACONS WAY, WATERBURY CENTER, VT 05677-8111
(802) 244-7647
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
0740000157
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0740000157
STATE LICENSE NUMBER
VT
Enumeration date
04/20/2007
Last updated
07/08/2007
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