Provider Demographics
NPI:1508632498
Name:RANDALL, COURTNEY LYNN (MS, RD, CD)
Entity Type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:LYNN
Last Name:RANDALL
Suffix:
Gender:F
Credentials:MS, RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1772 US ROUTE 7
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05733-9352
Mailing Address - Country:US
Mailing Address - Phone:802-377-5957
Mailing Address - Fax:
Practice Address - Street 1:302 MOUNTAIN VIEW DR STE 101
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-8081
Practice Address - Country:US
Practice Address - Phone:802-999-9207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered