Healthcare Provider Details

I. General information

NPI: 1326097296
Provider Name (Legal Business Name): MARY SUSAN PRUZINSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 SAINT FRANCIS DR STE 411
WATERLOO IA
50702-5619
US

IV. Provider business mailing address

2710 SAINT FRANCIS DR STE 411
WATERLOO IA
50702-5619
US

V. Phone/Fax

Practice location:
  • Phone: 319-272-5000
  • Fax: 319-272-5825
Mailing address:
  • Phone: 319-272-5000
  • Fax: 319-272-5825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number30009
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: