Provider Demographics
NPI:1457453888
Name:PRUETT, JUDIE (NP)
Entity Type:Individual
Prefix:MS
First Name:JUDIE
Middle Name:
Last Name:PRUETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF STATE
Mailing Address - Street 2:M-MED-QI 2401 E ST NW
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20522-0102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF STATE
Practice Address - Street 2:M-MED-QI 2401 E ST NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20522-0102
Practice Address - Country:US
Practice Address - Phone:202-663-2453
Practice Address - Fax:202-663-1661
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC960965363LA2100X, 363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology