Organization
NORTHWESTERN MEDICAL CENTER, INC.
Active
Other names
Northwestern Lifestyle Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY PIGEON (CREDENTIALING SPECIALIST)
(802) 524-8954
Entity
Organization
Contact information
Practice address
260 CREST RD, SUITE 202, SAINT ALBANS, VT 05478-9503
(802) 524-1227
(802) 524-8498
Mailing address
133 FAIRFIELD ST, SAINT ALBANS, VT 05478-1726
(802) 524-1227
(802) 524-8498
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
—
—
133V00000X
Registered Dietitian
—
—
136A00000X
Registered Dietetic Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0024685
GROUP PTAN
VT
Enumeration date
03/15/2007
Last updated
10/23/2018
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