Healthcare Provider Details

I. General information

NPI: 1073407037
Provider Name (Legal Business Name): ALLEVIATE PAIN AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 N MAIN STREET EXT STE 2C
WALLINGFORD CT
06492-2400
US

IV. Provider business mailing address

850 N MAIN STREET EXT
WALLINGFORD CT
06492-2400
US

V. Phone/Fax

Practice location:
  • Phone: 203-619-1722
  • Fax:
Mailing address:
  • Phone: 203-626-4203
  • Fax: 203-626-1624

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: MARY COLBURN
Title or Position: OWNER
Credential: APRN
Phone: 203-619-1722