Healthcare Provider Details

I. General information

NPI: 1790409605
Provider Name (Legal Business Name): AMBER L PRUETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDRENS DR
COLUMBUS OH
43205-2639
US

IV. Provider business mailing address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-8875
  • Fax: 614-722-1753
Mailing address:
  • Phone: 614-722-8875
  • Fax: 614-722-1753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number319458
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: