Provider Demographics
NPI:1477947000
Name:PINSONNEAULT, MAHALA (RN)
Entity Type:Individual
Prefix:
First Name:MAHALA
Middle Name:
Last Name:PINSONNEAULT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MAHALA
Other - Middle Name:
Other - Last Name:CONARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2838 VT ROUTE 65
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05036-9577
Mailing Address - Country:US
Mailing Address - Phone:802-276-3354
Mailing Address - Fax:
Practice Address - Street 1:2838 VT ROUTE 65
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:VT
Practice Address - Zip Code:05036-9577
Practice Address - Country:US
Practice Address - Phone:802-276-3354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026-0078009163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse