Healthcare Provider Details

I. General information

NPI: 1083255459
Provider Name (Legal Business Name): BRITTNEY ALYSSA ACCAVALLO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

650 LANSDOWNE WAY APT 107
NORWOOD MA
02062-2918
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-0000
  • Fax:
Mailing address:
  • Phone: 802-345-6708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number026.0088443
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number101-0134408
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: