Provider Demographics
NPI:1841417771
Name:PROFESSIONAL NURSES SERVICE, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL NURSES SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MISTIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MONFREDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-655-7111
Mailing Address - Street 1:94 W CANAL ST
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-2128
Mailing Address - Country:US
Mailing Address - Phone:802-655-7111
Mailing Address - Fax:802-655-8281
Practice Address - Street 1:94 W CANAL ST
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-2128
Practice Address - Country:US
Practice Address - Phone:802-655-7111
Practice Address - Fax:802-655-8281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT DOES NOT LICENSE251B00000X, 251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251E00000XAgenciesHome Health
Not Answered251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011977Medicaid
VT047W266Medicaid
VT1004791Medicaid
VT1005258Medicaid
VT477019Medicare ID - Type Unspecified
VT0VN0042Medicare ID - Type UnspecifiedHI-TECH
VT1004791Medicaid