Healthcare Provider Details

I. General information

NPI: 1912305061
Provider Name (Legal Business Name): ELIZABETH ANN PRUITT SAXTON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 09/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 COPPERMINE RD
WOODSBORO MD
21798-8319
US

IV. Provider business mailing address

610 SOLAREX CT
FREDERICK MD
21703-8624
US

V. Phone/Fax

Practice location:
  • Phone: 301-845-6322
  • Fax: 240-578-4480
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number026.0089477
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR218389
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: