Provider Demographics
NPI:1932997335
Name:ZENVANA MEDICAL AND WELLNESS GROUP LLC
Entity type:Organization
Organization Name:ZENVANA MEDICAL AND WELLNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:SIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMBA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:240-498-1879
Mailing Address - Street 1:33 MARKET POINT DR STE 2020
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5768
Mailing Address - Country:US
Mailing Address - Phone:240-498-1879
Mailing Address - Fax:
Practice Address - Street 1:33 MARKET POINT DR STE 2020
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5768
Practice Address - Country:US
Practice Address - Phone:240-498-1879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty