Individual
JOHN A PRU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
80 PERIMETER DRIVE, ALTA, WY 83414
(307) 421-3396
Mailing address
PO BOX 563, ALTA, WY 83414
(307) 421-3396
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
6780.0512
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016358
COUNCIL OF RECERT. ON NA
—
Enumeration date
04/24/2006
Last updated
07/08/2007
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