Provider Demographics
NPI:1821342221
Name:RANCOURT, GINA MARIE (MS, RDN, CD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:RANCOURT
Suffix:
Gender:F
Credentials:MS, RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-0122
Mailing Address - Country:US
Mailing Address - Phone:508-364-0461
Mailing Address - Fax:
Practice Address - Street 1:366 DORSET ST STE 10
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-4479
Practice Address - Country:US
Practice Address - Phone:802-999-9207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3368133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered