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General NPI Number Information
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NPI Number | 1114846888
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Entity Type | Organization
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Legal Business Name | ABUNDANT LIFE INTEGRATIVE MEDICINE LLC
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Dates
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Enumeration Date | 07/15/2026
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Last Update Date | 07/15/2026
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Provider Practice Location Address
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Address Line | 98 PANE RD UNIT 1106
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City | NEWINGTON
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State | CT
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Zip | 06111-5568
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Country | US
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Telephone | 860-507-9883
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Fax | 203-621-3172
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Provider Business Mailing Address
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Address Line | 1145 N COLONY RD STE 3
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City | WALLINGFORD
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State | CT
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Zip | 06492-1796
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Country | US
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Telephone | 860-507-9883
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Fax | 203-621-3172
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | ANAICA QUAO
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Credential | DNP, APRN
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Telephone | 860-507-9883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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