Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 101-0134408 | VT |
NPI | 1083255459 |
---|---|
Provider Name | Brittney Alyssa Accavallo |
First Address | Norwood, MA 02062-2918 |
Second Address | Burlington, VT 05401-1473 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2019 |
Last Update Date | 29/10/2019 |