Provider Demographics
NPI:1942866793
Name:LIVWELL PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:LIVWELL PAIN MANAGEMENT LLC
Other - Org Name:NA
Other - Org Type:Other Name
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:DR
Authorized Official - First Name:KRIPA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLAPETTA DAMODHARAN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP -BC
Authorized Official - Phone:203-443-9500
Mailing Address - Street 1:764 CAMPBELL AVE STE F
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-3786
Mailing Address - Country:US
Mailing Address - Phone:203-439-5000
Mailing Address - Fax:
Practice Address - Street 1:764 CAMPBELL AVE STE F
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-3786
Practice Address - Country:US
Practice Address - Phone:203-443-9500
Practice Address - Fax:203-902-0509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-17
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty