Provider Demographics
NPI:1568925634
Name:PRUNTY, MAGGIE MARIE (CNP)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:MARIE
Last Name:PRUNTY
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 1:1026 7TH ST W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-3828
Mailing Address - Country:US
Mailing Address - Phone:516-758-9500
Mailing Address - Fax:
Practice Address - Street 1:1026 7TH ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-3828
Practice Address - Country:US
Practice Address - Phone:651-758-9500
Practice Address - Fax:651-241-1058
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-07
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28238096A163W00000X
MN2288448163W00000X
MN6730363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse