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NPI Code Detail

MEDICARE: DR. ANDRA L PRUM D.O.

MEDICARE: DR. ANDRA L PRUM D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician1123NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CS11196OTHERNVPHARMACY/CDS

General Provider Information

NPI Number : 1326026824
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANDRA L PRUM D.O.
Provider Business Mailing Address
First Line : 11700 W CHARLESTON BLVD # 170-597
Second Line :
City : LAS VEGAS
State : NV
Zip : 89135-1573
Country : US
Telephone Number : 702-660-2024
Fax Number : 701-203-9648
Provider Business Practice Location Address
First Line : 8905 W POST RD STE 110
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-2429
Country : US
Telephone Number : 702-660-2024
Fax Number : 701-203-9648
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2006
Last Update Date : 09/16/2025

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Directions to “ DR. ANDRA L PRUM D.O.” Practice Location

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