Provider Demographics
NPI:1922874486
Name:PRUE, SARAH JO
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JO
Last Name:PRUE
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 1:530 SW FALL ST APT H
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-5055
Mailing Address - Country:US
Mailing Address - Phone:541-880-4638
Mailing Address - Fax:
Practice Address - Street 1:321 SE 3RD ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OR
Practice Address - Zip Code:97391-1613
Practice Address - Country:US
Practice Address - Phone:541-336-2254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist