MEDICARE: GINA PRUITT LPN

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	164W00000X	Licensed Practical Nurse	PN-146501-M-IV	OH

General Provider Information

NPI Number	:	1730421843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA PRUITT LPN

Provider Business Mailing Address
First Line	:	4119 E 147TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-1851
Country	:	US
Telephone Number	:	216-225-8202
Fax Number	:

Provider Business Practice Location Address
First Line	:	4119 E 147TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-1851
Country	:	US
Telephone Number	:	216-225-8202
Fax Number	:

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

Provider Enumeration Date	:	03/27/2013
Last Update Date	:	03/27/2013

Similar Medicare Providers

1396500054 — KELASHA DUDLEY
Practice Location Address:

1052 ROANOKE RD
CLEVELAND HTS, OH
44121-1851

Practice Phone: 216-799-3386
Practice Fax:

1386481133 — JAMILLA CLEVELAND
Practice Location Address:

1044 ROANOKE RD
CLEVELAND HTS, OH
44121-1851

Practice Phone: 216-543-4759
Practice Fax:

1184586505 — BRIGIDA ANT GIL
Practice Location Address:

4097 W 57TH ST
CLEVELAND, OH
44144-1851

Practice Phone: 216-799-7921
Practice Fax:

1427901941 — JASMINE CALLOWAY
Practice Location Address:

1851 BREVIER AVE APT 201
CLEVELAND, OH
44113-4336

Practice Phone: 216-804-5173
Practice Fax:

1518503309 — JAMAAL KEATON
Practice Location Address:

20571 ELLACOTT PKWY APT 621
CLEVELAND, OH
44128-4402

Practice Phone: 216-870-1736
Practice Fax:

1578406450 — ARIK EVANS
Practice Location Address:

17316 WAYNE DR
CLEVELAND, OH
44128-3371

Practice Phone: 440-404-9713
Practice Fax:

Directions to “ GINA PRUITT LPN” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.