Provider Demographics
NPI:1508971086
Name:PROFESSIONAL NURSES SERVICE INC
Entity Type:Organization
Organization Name:PROFESSIONAL NURSES SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCHENRY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:800-446-8773
Mailing Address - Street 1:110 KIMBALL AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6833
Mailing Address - Country:US
Mailing Address - Phone:800-446-8773
Mailing Address - Fax:802-861-2921
Practice Address - Street 1:110 KIMBALL AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6833
Practice Address - Country:US
Practice Address - Phone:800-446-8773
Practice Address - Fax:802-861-2921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT3747P1801X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN0042Medicaid
VT1004791Medicaid
VT047W266Medicaid
VT1011977Medicaid
VT1005258Medicaid
VT477019Medicare ID - Type UnspecifiedHOME HEALTH