Provider Demographics
NPI:1932570413
Name:PRUDER, CATHY
Entity Type:Individual
Prefix:MS
First Name:CATHY
Middle Name:
Last Name:PRUDER
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 1:517 TAWAS ST
Mailing Address - Street 2:
Mailing Address - City:EAST TAWAS
Mailing Address - State:MI
Mailing Address - Zip Code:48730-1316
Mailing Address - Country:US
Mailing Address - Phone:989-314-3059
Mailing Address - Fax:
Practice Address - Street 1:517 TAWAS ST
Practice Address - Street 2:
Practice Address - City:EAST TAWAS
Practice Address - State:MI
Practice Address - Zip Code:48730-1316
Practice Address - Country:US
Practice Address - Phone:989-314-3059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other