Provider Demographics
NPI:1871737510
Name:PRUETT, PAMELA JO (RN)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JO
Last Name:PRUETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:JO
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-0013
Mailing Address - Country:US
Mailing Address - Phone:314-971-6656
Mailing Address - Fax:
Practice Address - Street 1:910 FOX CHASE
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-1364
Practice Address - Country:US
Practice Address - Phone:314-971-6656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001018541163W00000X
TN154028163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse