Provider Demographics
NPI:1730294174
Name:PRUITT, UNNEETHA PHILOMENA (RN, NP)
Entity Type:Individual
Prefix:
First Name:UNNEETHA
Middle Name:PHILOMENA
Last Name:PRUITT
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2369
Mailing Address - Street 2:
Mailing Address - City:BORREGO SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92004-2369
Mailing Address - Country:US
Mailing Address - Phone:760-767-5051
Mailing Address - Fax:
Practice Address - Street 1:4343 YAQUI PASS RD.
Practice Address - Street 2:
Practice Address - City:BORREGO SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92004-2369
Practice Address - Country:US
Practice Address - Phone:760-767-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN402000163WG0000X
CANP14071363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice