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General NPI Number Information
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NPI Number | 1710531496
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Entity Type | Individual
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Provider Name | SHEILA RENEE HOLLAND PRUETT
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Gender | Female
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 3007 MEMORIAL PKWY SW STE A
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City | HUNTSVILLE
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State | AL
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Zip | 35801-5394
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Country | US
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Telephone | 256-799-2504
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Fax |
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Provider Business Mailing Address
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Address Line | 975 E 3RD ST
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City | CHATTANOOGA
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State | TN
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Zip | 37403-2147
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Country | US
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Telephone |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 1-145131
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License Number State | AL
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