Prisma Wellness, PLLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

PRISMA WELLNESS, PLLC

Practice address

13500 Watertown Plank Rd Ste 102
Elm Grove, WI 53122-2222

Phone

(206) 785-1015

Fax

(206) 785-1023

NPI assigned

Mar 17, 2022

Organization subpart

Yes

Parent organization

PRISMA WELLNESS, PLLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Scott Wiener, MD

Title

Chief Medical Officer

Phone

(206) 785-1015

Specialties & licenses 3

Addresses

Other names 1

• Prisma Wellness, PLLC Doing business as

Electronic endpoints 1

Tax ID family

Prisma Wellness PLLC3 organizations share this tax ID, including this one

Part of

Prisma Wellness PLLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Prisma Wellness, PLLC

  • Psychiatry Physician
  • Renton, WA
  • NPI 1093351496
  NPD tax ID
• Prisma Wellness, PLLC

  • Psychiatry Physician
  • Virginia Beach, VA
  • NPI 1598412504
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647475200000",
    "number": "1114675162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2031 RIDGE END RD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234541028",
            "telephone_number": "206-939-1456",
            "fax_number": "206-785-1023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13500 WATERTOWN PLANK RD STE 102",
            "city": "ELM GROVE",
            "state": "WI",
            "postal_code": "531222222",
            "telephone_number": "206-785-1015",
            "fax_number": "206-785-1023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISMA WELLNESS, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRISMA WELLNESS, PLLC",
        "enumeration_date": "2022-03-17",
        "last_updated": "2022-03-17",
        "certification_date": "2022-03-17",
        "status": "A",
        "authorized_official_last_name": "WIENER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "206-785-1015",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "364SP0809X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Adult",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "2067851023",
            "affiliation": "Y",
            "endpointDescription": "Secure Fax",
            "affiliationName": "Prisma Wellness, PLLC",
            "address_1": "305 111th Ave NE Ste B",
            "city": "Bellevue",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980048361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Prisma Wellness, PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Loren-Ashley Peterson, PHARMD
• Jill M Petryczkiewycz, PHYSICAL THERAPIST
• Margaret Ann Pofahl, LCSW
• Julie D Powers, PHYSICAL THERAPY ASS
• Prisma Health PLLC
• Prisma Wisconsin LLC
• Jessica Ramintho, APNP
• Jelanny Ramirez Pavon
• Arthur Dudley Rapkin, O.M.D.
• Lana Rasmuaaen

• Psychiatric/Mental Health Nurse Practitioner in Elm Grove, WI
• Providers in Elm Grove, WI by specialty
• Psychiatric/Mental Health Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.