Provider Demographics
NPI:1265086037
Name:ROULEAU, ABBEY LYNNE (NP)
Entity type:Individual
Prefix:
First Name:ABBEY
Middle Name:LYNNE
Last Name:ROULEAU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CVMC PALLIATIVE CARE
Mailing Address - Street 2:130 FISHER ROAD 2ND FLOOR
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602
Mailing Address - Country:US
Mailing Address - Phone:802-371-5372
Mailing Address - Fax:
Practice Address - Street 1:CVMC PALLIATIVE CARE
Practice Address - Street 2:130 FISHER ROAD 2ND FLOOR
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602
Practice Address - Country:US
Practice Address - Phone:802-371-5372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0134379363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner