Provider Demographics
NPI:1982208831
Name:PRUITT, DEEOZJA
Entity Type:Individual
Prefix:
First Name:DEEOZJA
Middle Name:
Last Name:PRUITT
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 1:3757 WESTMONT DR APT 12
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45205-1240
Mailing Address - Country:US
Mailing Address - Phone:513-291-2702
Mailing Address - Fax:
Practice Address - Street 1:3757 WESTMONT DR APT 12
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45205-1240
Practice Address - Country:US
Practice Address - Phone:513-291-2702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-22
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide