Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 0420010535 | VT |
Y | 208600000X | Surgeon | 0420010535 | VT |
NPI | 1013975341 |
---|---|
Provider Name | Cathryn Dyeanne Racette |
First Address | Morrisville, VT 05661 |
Second Address | Morrisville, VT 05661 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00059226 | BLUE CROSS BLUE SHIELD (01) | VT |
1009492 | (05) | VT |
E83724 | (02) | |
P00063913 | RAILROAD MEDICARE (01) |