Healthcare Provider Details

I. General information

NPI: 1053847608
Provider Name (Legal Business Name): CIARA PRUITT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 FRONT ST
BEREA OH
44017-1943
US

IV. Provider business mailing address

20265 EMERY RD
NORTH RANDALL OH
44128-4122
US

V. Phone/Fax

Practice location:
  • Phone: 440-523-9966
  • Fax: 216-584-2895
Mailing address:
  • Phone: 440-523-9966
  • Fax: 216-584-2895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.020801
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: