Individual
SHENISE LASTINE PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9648 OLIVE BLVD, OLIVETTE, MO 63132-3002
(314) 641-9930
Mailing address
9648 OLIVE BLVD, OLIVETTE, MO 63132-3002
(314) 641-9930
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
MO
Other
Enumeration date
04/16/2010
Last updated
04/16/2010
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