Provider Demographics
NPI:1437512365
Name:PRUS, REBECCA ANTOINETTE
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANTOINETTE
Last Name:PRUS
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 1:31544 NELSON DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-1827
Mailing Address - Country:US
Mailing Address - Phone:586-214-6571
Mailing Address - Fax:
Practice Address - Street 1:31544 NELSON DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-1827
Practice Address - Country:US
Practice Address - Phone:586-214-6571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other