MEDICARE: ASHLEE ANN KAREUS PRUETT 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
1	207L00000X	Anesthesiology Physician	007317	AZ

General Provider Information

NPI Number	:	1487911491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEE ANN KAREUS PRUETT D.O.

Provider Business Mailing Address
First Line	:	1380 W WINDHAVEN AVE
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85233-5145
Country	:	US
Telephone Number	:	970-201-1858
Fax Number	:

Provider Business Practice Location Address
First Line	:	5110 N 44TH ST STE L200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-1675
Country	:	US
Telephone Number	:	602-343-2900
Fax Number	:	602-343-2901

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2012
Last Update Date	:	04/30/2018

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