Provider Demographics
NPI:1639465800
Name:PRUDEN, SHANON MIRANDA (CLD(CBI))
Entity Type:Individual
Prefix:MRS
First Name:SHANON
Middle Name:MIRANDA
Last Name:PRUDEN
Suffix:
Gender:F
Credentials:CLD(CBI)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 HAVEN CT APT F
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-1815
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:83 HAVEN CT APT F
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-1815
Practice Address - Country:US
Practice Address - Phone:360-990-8549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-25
Last Update Date:2011-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula