Individual
NICHOLAS JAMES PRUETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4801 W 81ST ST STE 112, BLOOMINGTON, MN 55437-1111
(952) 345-3000
(952) 345-6789
Mailing address
4801 W 81ST ST STE 112, BLOOMINGTON, MN 55437-1111
(952) 345-3000
(952) 345-6789
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10813
MN
363AS0400X
Surgical Physician Assistant
10813
MN
Other
Enumeration date
08/11/2010
Last updated
05/20/2025
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