Provider Demographics
NPI:1437132362
Name:MALONE-RISING, DOROTHY (ANP)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:
Last Name:MALONE-RISING
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 LOWER MAIN W
Mailing Address - Street 2:PO BOX 318
Mailing Address - City:JOHNSON
Mailing Address - State:VT
Mailing Address - Zip Code:05656-9632
Mailing Address - Country:US
Mailing Address - Phone:802-635-6689
Mailing Address - Fax:802-635-7435
Practice Address - Street 1:384 LOWER MAIN W
Practice Address - Street 2:
Practice Address - City:JOHNSON
Practice Address - State:VT
Practice Address - Zip Code:05656-9632
Practice Address - Country:US
Practice Address - Phone:802-635-6689
Practice Address - Fax:802-635-7435
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0013373363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT698178OtherMVP INSURANCE
VT29381OtherBCBS OF VT
VT49123OtherBLUE CROSS MANAGED CARE
VTONP0730Medicaid
VT29381OtherBCBS OF VT
VT698178OtherMVP INSURANCE