Individual
MRS. DEBRA KAYE PRUDHOM III
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
3613 KINZIE AVE, RACINE, WI 53405-2440
(262) 632-4394
Mailing address
3613 KINZIE AVE, RACINE, WI 53405-2440
(262) 632-4394
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
80117
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38282800
—
WI
Enumeration date
03/17/2006
Last updated
07/09/2007
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