Provider Demographics
NPI:1336476225
Name:PRUDOFF, ALISON MICHELLE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:MICHELLE
Last Name:PRUDOFF
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 EASTWAY DR
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44242-3001
Mailing Address - Country:US
Mailing Address - Phone:330-672-2322
Mailing Address - Fax:
Practice Address - Street 1:1500 EASTWAY DR
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44242-3001
Practice Address - Country:US
Practice Address - Phone:330-672-2322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.10699-NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health