Healthcare Provider Details

I. General information

NPI: 1205916657
Provider Name (Legal Business Name): NANCY B. PRUNTY N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 N DODGE BLVD
TUCSON AZ
85716-2671
US

IV. Provider business mailing address

9085 E BELLEVUE ST
TUCSON AZ
85715-5602
US

V. Phone/Fax

Practice location:
  • Phone: 520-618-8747
  • Fax: 520-882-5676
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN048305
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: