Provider Demographics
NPI:1558625681
Name:PRUITT, JAMARR A (CARDIO PHLEBOTOMIST)
Entity Type:Individual
Prefix:
First Name:JAMARR
Middle Name:A
Last Name:PRUITT
Suffix:
Gender:M
Credentials:CARDIO PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17350 PARK LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-7714
Mailing Address - Country:US
Mailing Address - Phone:313-475-1293
Mailing Address - Fax:
Practice Address - Street 1:17350 PARK LN
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-7714
Practice Address - Country:US
Practice Address - Phone:313-475-1293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program