MEDICARE: PRIVY WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner

General Provider Information

NPI Number	:	1528777067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIVY WELLNESS

Provider Business Mailing Address
First Line	:	24137 LONG VALLEY RD
Second Line	:
City	:	HIDDEN HILLS
State	:	CA
Zip	:	91302-1249
Country	:	US
Telephone Number	:	805-341-3326
Fax Number	:

Provider Business Practice Location Address
First Line	:	24137 LONG VALLEY RD
Second Line	:
City	:	HIDDEN HILLS
State	:	CA
Zip	:	91302-1249
Country	:	US
Telephone Number	:	805-341-3326
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VERNA SIMEONE PRYOR
Credential	:	NP
Telephone Number	:	805-341-3326

Provider Enumeration Date	:	11/22/2022
Last Update Date	:	11/22/2022

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Directions to “PRIVY WELLNESS ” Practice Location

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