Provider Demographics
NPI:1255807541
Name:PRUETT, CARLA (CNA)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:PRUETT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6140 PANAMA RD
Mailing Address - Street 2:
Mailing Address - City:SORRENTO
Mailing Address - State:LA
Mailing Address - Zip Code:70778-3601
Mailing Address - Country:US
Mailing Address - Phone:225-461-9687
Mailing Address - Fax:
Practice Address - Street 1:6140 PANAMA RD
Practice Address - Street 2:
Practice Address - City:SORRENTO
Practice Address - State:LA
Practice Address - Zip Code:70778-3601
Practice Address - Country:US
Practice Address - Phone:225-461-9892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011402807251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care