| Vivid Aesthetics & Wellness Pllc | |
|
110 Court St Cromwell CT 06416-1273 | |
| (860) 250-9017 | |
| Not Available |
| Full Name | Vivid Aesthetics & Wellness Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 110 Court St, Cromwell, Connecticut |
| Authorized Official Name and Position | Selma Costa Rosa (NURSE PRACTIONER) |
| Authorized Official Contact | 8602509017 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vivid Aesthetics & Wellness Pllc 110 Court St Cromwell CT 06416-1273 Ph: () - | Vivid Aesthetics & Wellness Pllc 110 Court St Cromwell CT 06416-1273 Ph: (860) 250-9017 |
| NPI Number | 1861260671 |
|---|---|
| Provider Enumeration Date | 12/12/2023 |
| Last Update Date | 12/06/2024 |
| Medicare PECOS PAC ID | 9133656531 |
|---|---|
| Medicare Enrollment ID | O20241226000110 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861260671 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Brian B Gomes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669972444 PECOS PAC ID: 2466715560 Enrollment ID: I20180423002689 |
| Provider Name | Lynn S. Swanson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073082343 PECOS PAC ID: 2961749486 Enrollment ID: I20190122003141 |
| Provider Name | Selma Costa Rosa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457930158 PECOS PAC ID: 0446641989 Enrollment ID: I20211217000352 |
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