Provider Demographics
NPI:1477568913
Name:BEYNNON, BONNIE JEAN (RD CD CNSD)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:JEAN
Last Name:BEYNNON
Suffix:
Gender:F
Credentials:RD CD CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 COLCHESTER AVE
Mailing Address - Street 2:ENGINEERING 328
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1473
Mailing Address - Country:US
Mailing Address - Phone:802-847-3640
Mailing Address - Fax:802-847-2790
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:ENGINEERING 328
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-3640
Practice Address - Fax:802-847-2790
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT074-0000128133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic