Provider Demographics
NPI:1528777067
Name:PRIVY WELLNESS
Entity type:Organization
Organization Name:PRIVY WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERNA
Authorized Official - Middle Name:SIMEONE
Authorized Official - Last Name:PRYOR
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:805-341-3326
Mailing Address - Street 1:24137 LONG VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HIDDEN HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1249
Mailing Address - Country:US
Mailing Address - Phone:805-341-3326
Mailing Address - Fax:
Practice Address - Street 1:24137 LONG VALLEY RD
Practice Address - Street 2:
Practice Address - City:HIDDEN HILLS
Practice Address - State:CA
Practice Address - Zip Code:91302-1249
Practice Address - Country:US
Practice Address - Phone:805-341-3326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty