Provider Demographics
NPI:1750370607
Name:PRUCKA, SANDRA KATHARINA (MS)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:KATHARINA
Last Name:PRUCKA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 3RD AVE S
Mailing Address - Street 2:KAUL 202C
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0002
Mailing Address - Country:US
Mailing Address - Phone:205-934-9500
Mailing Address - Fax:205-975-6389
Practice Address - Street 1:1530 3RD AVE S
Practice Address - Street 2:KAUL 202C
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0002
Practice Address - Country:US
Practice Address - Phone:205-934-9500
Practice Address - Fax:205-975-6389
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS