Pruitt, Douglas

Pruitt, Douglas is an individual health care provider with primary practice located at 600 East Blvd , Elkhart IN 46514-2483. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Pruitt, Douglas can be contacted via phone (574) 524-8130.

Contact Information

Primary practice address
600 East Blvd Elkhart IN 46514-2483
Phone: (574) 524-8130
Fax: (574) 524-8138
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 28162626 Indiana
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 28155497A Indiana

Profile Details

NPI number 1366493579
LBN Legal business name Pruitt, Douglas
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date May 12th, 2006
Last updated Jan 28th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366493579 NPPES
Indiana MEDICAID 200047710

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