Provider Demographics
NPI:1235143140
Name:MCISAAC, CATHERINE L (RD)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:L
Last Name:MCISAAC
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W CANAL ST
Mailing Address - Street 2:#41
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-2153
Mailing Address - Country:US
Mailing Address - Phone:802-847-2703
Mailing Address - Fax:802-847-2710
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:NUTRITION SERVICES 320 ENGINEERING
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-2703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT074-0000183133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered