Provider Demographics
NPI:1336705433
Name:PERREAULT, ALEXANDRA (APRN)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:PERREAULT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:BORDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 755
Mailing Address - Street 2:
Mailing Address - City:WELLS RIVER
Mailing Address - State:VT
Mailing Address - Zip Code:05081-0755
Mailing Address - Country:US
Mailing Address - Phone:802-757-2325
Mailing Address - Fax:802-757-3215
Practice Address - Street 1:1080 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-6001
Practice Address - Country:US
Practice Address - Phone:802-473-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0134286363LF0000X
NH072345-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily