Provider Demographics
NPI:1235976259
Name:PRATT, THEAREON ROBERT (RN)
Entity type:Individual
Prefix:MR
First Name:THEAREON
Middle Name:ROBERT
Last Name:PRATT
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 E YOSEMITE AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-9167
Mailing Address - Country:US
Mailing Address - Phone:209-724-5411
Mailing Address - Fax:
Practice Address - Street 1:340 E YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-9167
Practice Address - Country:US
Practice Address - Phone:209-724-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA690819163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice