MEDICARE: BROOKLYN HOPE PRUTER

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	231H00000X	Audiologist	2201002022	VA
2	231H00000X	Audiologist	2487	KS

General Provider Information

NPI Number	:	1861116790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKLYN HOPE PRUTER

Provider Business Mailing Address
First Line	:	241 CHARLES H DIMMOCK PKWY STE 6
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2915
Country	:	US
Telephone Number	:	804-765-5320
Fax Number	:

Provider Business Practice Location Address
First Line	:	241 CHARLES H DIMMOCK PKWY STE 6
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2915
Country	:	US
Telephone Number	:	804-765-5320
Fax Number	:

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

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	03/03/2026

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Directions to “ BROOKLYN HOPE PRUTER ” Practice Location

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