Provider Demographics
NPI:1902358476
Name:ROZENDAAL, ELISE (FNP)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:ROZENDAAL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:
Other - Last Name:MACVARISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-0749
Mailing Address - Country:US
Mailing Address - Phone:802-851-8606
Mailing Address - Fax:
Practice Address - Street 1:607 WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-8652
Practice Address - Country:US
Practice Address - Phone:802-888-5639
Practice Address - Fax:802-888-6040
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0125739363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health