Healthcare Provider Details

I. General information

NPI: 1992038368
Provider Name (Legal Business Name): SHARON L MANSFIELD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 WASHINGTON HWY
MORRISVILLE VT
05661-8973
US

IV. Provider business mailing address

555 WASHINGTON HWY
MORRISVILLE VT
05661-8972
US

V. Phone/Fax

Practice location:
  • Phone: 802-888-4231
  • Fax: 802-888-8203
Mailing address:
  • Phone: 802-888-8405
  • Fax: 802-888-8203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1010122724
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF336014-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: