Healthcare Provider Details

I. General information

NPI: 1306752092
Provider Name (Legal Business Name): NEVAEH PRUNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 LARCHWOOD RD
MANSFIELD OH
44907-2424
US

IV. Provider business mailing address

20 S LINDEN RD 20A APT 110
MANSFIELD OH
44906
US

V. Phone/Fax

Practice location:
  • Phone: 419-747-4122
  • Fax:
Mailing address:
  • Phone: 419-565-1899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: