Provider Demographics
NPI:1699002642
Name:PRYOR, ANN G
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:G
Last Name:PRYOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 E. WAYNE ST.
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615
Mailing Address - Country:US
Mailing Address - Phone:574-282-1005
Mailing Address - Fax:574-282-1005
Practice Address - Street 1:1516 E. WAYNE ST.
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615
Practice Address - Country:US
Practice Address - Phone:574-282-1005
Practice Address - Fax:574-282-1005
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor