Provider Demographics
NPI:1598254633
Name:PRUETT, ELISABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:
Last Name:PRUETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 OXFORD DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2355
Mailing Address - Country:US
Mailing Address - Phone:412-687-3900
Mailing Address - Fax:412-372-1064
Practice Address - Street 1:600 OXFORD DR STE 200
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2355
Practice Address - Country:US
Practice Address - Phone:412-687-3900
Practice Address - Fax:412-372-1064
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA059735363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical