Individual
DAXTEN PRUTER
Active
Individual
DAXTEN PRUTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0121556
OK
363LF0000X
Family Nurse Practitioner
Primary
53-79163-032
KS
Other
Enumeration date
08/24/2016
Last updated
11/19/2020
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