Lisa E Rostvold

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

CPED2624 Issued in IN

Legal business name

LISA E ROSTVOLD

Doing business as

Blue Moon Shoes

Practice address

110 N Buffalo St
Warsaw, IN 46580-2754

Phone

(574) 267-5537

Fax

(574) 267-6165

NPI assigned

Feb 14, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Lisa Ellen Rostvold, CERTIFIED PEDORTHIST

Title

Owner

Phone

(574) 267-5537

Specialties & licenses 1

Addresses

Other names 1

• Blue Moon Shoes Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213833600000",
    "number": "1558539338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 N BUFFALO ST",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "465802754",
            "telephone_number": "574-267-5537",
            "fax_number": "574-267-6165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 N BUFFALO ST",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "465802754",
            "telephone_number": "574-267-5537",
            "fax_number": "574-267-6165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LISA E ROSTVOLD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-14",
        "last_updated": "2008-06-19",
        "status": "A",
        "authorized_official_last_name": "ROSTVOLD",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "ELLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "574-267-5537",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CERTIFIED PEDORTHIST"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "IN",
            "license": "CPED2624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Moon Shoes",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alyssa Lewis
• Vicki E Ley, LMHC
• Hester Siquilla Liebetrau, PSYD, HSPP, LMHC
• Jesenia Guadalupe Linares Moctezuma, RDH
• Amslie Lippencott
• Tara Janae Little, FNP
• Daniel Louis Loney, D.O.
• Emma L. Long, M.D.
• Sadra Long
• Braydon Lowe

• Prosthetic/Orthotic Supplier in Warsaw, IN
• Providers in Warsaw, IN by specialty
• Prosthetic/Orthotic Supplier in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.