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:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT DOES NOT LICENSE251B00000X, 251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011977Medicaid
VT047W266Medicaid
VT1004791Medicaid
VT1005258Medicaid
VT477019Medicare ID - Type Unspecified
VT0VN0042Medicare ID - Type UnspecifiedHI-TECH
VT1004791Medicaid