Provider Demographics
NPI:1619379070
Name:PRUIS, JOSEPH RYNE (CRNA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RYNE
Last Name:PRUIS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:640 JACKSON ST
Mailing Address - Street 2:DEPT OF ANESTHESIA
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2502
Mailing Address - Country:US
Mailing Address - Phone:651-254-6512
Mailing Address - Fax:651-254-3048
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:DEPT OF ANESTHESIA
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-6512
Practice Address - Fax:651-254-3048
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNCRNA 1742367500000X
IAD136694367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered