Provider Demographics
NPI:1952054124
Name:NUTMEG WELLNESS LLC
Entity Type:Organization
Organization Name:NUTMEG WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, APRN
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYERL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:203-680-0734
Mailing Address - Street 1:2661 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-2900
Mailing Address - Country:US
Mailing Address - Phone:203-680-0734
Mailing Address - Fax:
Practice Address - Street 1:2661 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-2900
Practice Address - Country:US
Practice Address - Phone:203-680-0734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-28
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty