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Individual
MISS MARI PRUKS
Active
Individual
MISS MARI PRUKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.S.W.
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801090128
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0960419
BCBS
MI
Enumeration date
10/18/2011
Last updated
02/08/2012
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