Provider Demographics
NPI:1841595808
Name:VINCENT, RACHEL LUCIA (RD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LUCIA
Last Name:VINCENT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:LUCIA
Other - Last Name:WYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:41 DONALD B DEAN DR STE A
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3252
Mailing Address - Country:US
Mailing Address - Phone:207-661-6064
Mailing Address - Fax:
Practice Address - Street 1:41 DONALD B DEAN DR STE A
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-3252
Practice Address - Country:US
Practice Address - Phone:207-661-6064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2973133V00000X
MEDI1522133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered