Individual
MS. CHARLEEN L PRUETT
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
23606 SHEPARD RD, CLATSKANIE, OR 97016-2331
(503) 728-4770
Mailing address
PO BOX 276, 23606 SHEPERD RD., CLATSKANIE, OR 97016-0276
(503) 728-4770
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
90007050
OR
363LA2200X
Adult Health Nurse Practitioner
AP30002308
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78969
—
OR
Enumeration date
11/10/2005
Last updated
07/09/2007
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