Provider Demographics
NPI:1487636288
Name:ROSALES, LOUISE MOON (FNP)
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:MOON
Last Name:ROSALES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 TARBOX RD
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:VT
Mailing Address - Zip Code:05465-9603
Mailing Address - Country:US
Mailing Address - Phone:802-899-3073
Mailing Address - Fax:802-654-2699
Practice Address - Street 1:1 WINOOSKI PARK
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05439-0001
Practice Address - Country:US
Practice Address - Phone:802-654-2234
Practice Address - Fax:802-654-2699
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0023382363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily