Individual
REBECCA PRUELLA ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
785 SUMMIT AVE STE 101, PROHEALTH CARE WOMEN'S CENTER, OCONOMOWOC, WI 53066-3844
(262) 569-0345
(262) 569-0333
Mailing address
N17W24100 RIVERWOOD DR STE 250, PROHEALTH CARE MEDICAL ASSOCIATES, WAUKESHA, WI 53188-1177
(262) 473-5655
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
2574-033
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
41266700
WISCONSIN MEDICAID PROGRAM
WI
Enumeration date
08/20/2006
Last updated
01/16/2012
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