Provider Demographics
NPI:1912121278
Name:BELLROSE, SHARON MICHELLE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:SHARON
Middle Name:MICHELLE
Last Name:BELLROSE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:SHARON
Other - Middle Name:MICHELLE
Other - Last Name:JARVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:36 1 2 GREENWICH ST
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:VT
Mailing Address - Zip Code:05488
Mailing Address - Country:US
Mailing Address - Phone:802-868-2851
Mailing Address - Fax:
Practice Address - Street 1:38 WHIPPLE RD
Practice Address - Street 2:
Practice Address - City:SOUTH HERO
Practice Address - State:VT
Practice Address - Zip Code:05486-4900
Practice Address - Country:US
Practice Address - Phone:802-372-4020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT025-0008403164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1012237Medicaid