Healthcare Provider Details

I. General information

NPI: 1598689085
Provider Name (Legal Business Name): ALEXANDRA JOHNSON AVERILL ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLY AVERILL ND

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 IDX DR STE 220
SOUTH BURLINGTON VT
05403-7781
US

IV. Provider business mailing address

65 WINOOSKI FALLS WAY APT 311
WINOOSKI VT
05404-2261
US

V. Phone/Fax

Practice location:
  • Phone: 802-448-3388
  • Fax: 802-448-3387
Mailing address:
  • Phone: 802-448-3388
  • Fax: 802-448-3387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: