Provider Demographics
NPI:1417229063
Name:PRUETER, KAREN
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:PRUETER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 WESTOVER TER
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7130
Mailing Address - Country:US
Mailing Address - Phone:336-501-3796
Mailing Address - Fax:336-333-5477
Practice Address - Street 1:1507 WESTOVER TER
Practice Address - Street 2:SUITE B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7130
Practice Address - Country:US
Practice Address - Phone:336-501-3796
Practice Address - Fax:336-333-5477
Is Sole Proprietor?:No
Enumeration Date:2012-01-28
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03291363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical