Healthcare Provider Details

I. General information

NPI: 1376172411
Provider Name (Legal Business Name): GABRIELLA PETRELLI ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 KILBURN ST
BURLINGTON VT
05401-4750
US

IV. Provider business mailing address

375 NORTH AVE APT 402
BURLINGTON VT
05401-2953
US

V. Phone/Fax

Practice location:
  • Phone: 802-238-8603
  • Fax:
Mailing address:
  • Phone: 708-601-5020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number099.0134117
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: