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General NPI Number Information
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NPI Number | 1336190487
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Entity Type | Individual
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Provider Name | JEAN M PRUNTY MD
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Gender | Female
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Dates
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Enumeration Date | 05/13/2006
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Last Update Date | 03/22/2018
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Provider Practice Location Address
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Address Line | 609 WASHINGTON HWY
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City | MORRISVILLE
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State | VT
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Zip | 05661-8652
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Country | US
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Telephone | 802-888-5688
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Fax | 802-888-6818
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Provider Business Mailing Address
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Address Line | 607 WASHINTON HIGHWAY
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City | MORRISVILLE
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State | VT
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Zip | 05661-8715
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Country | US
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Telephone | 802-888-5688
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 042-0008373
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License Number State | VT
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