Individual
SHANIKA SHANTA PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1400 LEMAY FERRY RD, SAINT LOUIS, MO 63125
(314) 827-6868
(314) 627-4546
Mailing address
225 SAINT LOUIS AVE UNIT 11169, SAINT LOUIS, MO 63135-2783
(314) 827-6868
(314) 627-4546
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2017000938
MO
Other
Enumeration date
01/25/2017
Last updated
12/08/2021
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