Healthcare Provider Details

I. General information

NPI: 1497667836
Provider Name (Legal Business Name): WALNUT HILL PAIN AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GROVE ST FL 2
NEW BRITAIN CT
06053-4116
US

IV. Provider business mailing address

1 GROVE ST FL 2
NEW BRITAIN CT
06053-4116
US

V. Phone/Fax

Practice location:
  • Phone: 860-506-5050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LEONARDO MARQUEZ
Title or Position: PROVIDER
Credential: APRN
Phone: 860-712-3568