Provider Demographics
NPI:1720685746
Name:SHUMAKER-PRUITT, MARVI (RN)
Entity Type:Individual
Prefix:MS
First Name:MARVI
Middle Name:
Last Name:SHUMAKER-PRUITT
Suffix:
Gender:F
Credentials:RN
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 261
Mailing Address - Street 2:
Mailing Address - City:PORT ORFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97465-0261
Mailing Address - Country:US
Mailing Address - Phone:541-514-4697
Mailing Address - Fax:
Practice Address - Street 1:9934 8TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-3036
Practice Address - Country:US
Practice Address - Phone:206-477-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN.RN.61077124163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse