=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891609491
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORE & GLOW WELLNESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2026
-----------------------------------------------------
Last Update Date | 09/30/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 BISCUIT HILL DR
-----------------------------------------------------
City | LEOMINSTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01453-3968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-490-8227
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17 PIERCE AVE # 104
-----------------------------------------------------
City | FITCHBURG
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01420-7111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 351-209-6377
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | CYNTHIA GERONIMO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 351-209-6377
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------