Provider Demographics
NPI:1265892541
Name:SWAN INTEGRATIVE HEALTH & WELLNESS LLC
Entity type:Organization
Organization Name:SWAN INTEGRATIVE HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SWAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, DNP
Authorized Official - Phone:860-325-2679
Mailing Address - Street 1:PO BOX 290650
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06129-0650
Mailing Address - Country:US
Mailing Address - Phone:860-670-6626
Mailing Address - Fax:860-316-4064
Practice Address - Street 1:49 WELLES ST STE 215
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4205
Practice Address - Country:US
Practice Address - Phone:860-325-2679
Practice Address - Fax:860-316-4064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008069858Medicaid
CT008092242Medicaid