Healthcare Provider Details

I. General information

NPI: 1124940986
Provider Name (Legal Business Name): ADVANCED HEALTH & WELLNESS PRACTICE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 PROSPECT AVE FL 1-1004
WEST HARTFORD CT
06105-2965
US

IV. Provider business mailing address

PO BOX 1425
SOUTHWICK MA
01077-1425
US

V. Phone/Fax

Practice location:
  • Phone: 413-238-1446
  • Fax: 413-216-2939
Mailing address:
  • Phone: 413-238-1446
  • Fax: 413-216-2939

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: LISA KILLIPS
Title or Position: FAMILY NURSE PRACTITIONER
Credential: APRN
Phone: 413-238-1446