Provider Demographics
NPI:1932416575
Name:ROUSE, VONNIE LYNNE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:VONNIE
Middle Name:LYNNE
Last Name:ROUSE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:VONNIE
Other - Middle Name:LYNNE
Other - Last Name:BAGWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:3740 FALL RIVER RD
Mailing Address - Street 2:
Mailing Address - City:IDAHO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80452
Mailing Address - Country:US
Mailing Address - Phone:303-246-7990
Mailing Address - Fax:
Practice Address - Street 1:3740 FALL RIVER RD
Practice Address - Street 2:
Practice Address - City:IDAHO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80452
Practice Address - Country:US
Practice Address - Phone:303-246-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10347363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO85627321Medicaid
CO85627321Medicaid