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General NPI Number Information
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NPI Number | 1942050992
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Entity Type | Individual
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Provider Name | REBECCA PRUITT
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Gender | Female
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Dates
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Enumeration Date | 03/25/2024
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 4400 NE 77TH AVE STE 275
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City | VANCOUVER
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State | WA
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Zip | 98662-6857
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Country | US
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Telephone | 208-993-9234
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Fax |
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Provider Business Mailing Address
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Address Line | 13 E KIM ST
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City | SALMON
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State | ID
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Zip | 83467-5092
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Country | US
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Telephone | 832-443-9688
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 61535375
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License Number State | WA
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