Provider Demographics
NPI:1184477044
Name:CUSHMAN, S ELISE BRATCHER (RD)
Entity type:Individual
Prefix:
First Name:S ELISE
Middle Name:BRATCHER
Last Name:CUSHMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:BRATCHER
Other - Last Name:CUSHMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:THETFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05074-0052
Mailing Address - Country:US
Mailing Address - Phone:802-333-9003
Mailing Address - Fax:
Practice Address - Street 1:3522 RT 113
Practice Address - Street 2:
Practice Address - City:THETFORD
Practice Address - State:VT
Practice Address - Zip Code:05074
Practice Address - Country:US
Practice Address - Phone:802-333-9003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0613133VN1301X
VT074.0134366133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology