Organization Name: | AVALON NATURAL MEDICINE OF VERMONT, LLC |
NPI Number: | 1033486493 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHELLE KATHRYN HAFF (OWNER/MEDICAL DIRECTOR) |
Mailing Address: | 299 College Street Burlington |
State: | VT US |
Postal Code: | 05401 |
Phone Number: | 8025783449 |
Fax Number: | 8778161002 |
NPI Enumeration Date: | 11/29/2011 |
NPI Last Update Date: | 01/30/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 099.0081901 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | VT |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |