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General NPI Number Information
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NPI Number | 1356472161
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Entity Type | Individual
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Provider Name | MICHAEL GEORGE PRUNER ARNP
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Gender | Male
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 25647 REDWOOD HWY
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City | CAVE JUNCTION
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State | OR
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Zip | 97523-9332
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Country | US
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Telephone | 541-592-4111
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Fax | 541-592-3916
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Provider Business Mailing Address
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Address Line | 1701 NW HAWTHORNE AVE
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City | GRANTS PASS
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State | OR
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Zip | 97526-1257
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Country | US
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Telephone | 541-592-4111
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Fax | 541-592-3916
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | ARNP 3366972
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 201394159NP-PP
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License Number State | OR
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