Provider Demographics
NPI:1922189786
Name:DESORCY, ANICK PAULINE (RD)
Entity Type:Individual
Prefix:MISS
First Name:ANICK
Middle Name:PAULINE
Last Name:DESORCY
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 1:10 PLEASANT STREET
Mailing Address - Street 2:
Mailing Address - City:STANSTEAD
Mailing Address - State:QUEBEC
Mailing Address - Zip Code:J0B3E2
Mailing Address - Country:CA
Mailing Address - Phone:819-876-2596
Mailing Address - Fax:
Practice Address - Street 1:189 PROUTY DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-9326
Practice Address - Country:US
Practice Address - Phone:802-334-4155
Practice Address - Fax:802-334-3585
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0740000150133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered