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General NPI Number Information
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NPI Number | 1548476336
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Entity Type | Individual
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Provider Name | JEAN MARIE PRUITT L.P.N.
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Gender | Female
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 555 LEXINGTON AVE
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City | MANSFIELD
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State | OH
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Zip | 44907-1502
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Country | US
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Telephone | 419-774-4500
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Fax | 419-774-4585
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Provider Business Mailing Address
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Address Line | 4502 MILL RUN RD
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City | LEXINGTON
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State | OH
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Zip | 44904-9598
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Country | US
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Telephone | 419-884-1492
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN071105
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License Number State | OH
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