Individual
ELIZABETH PRUETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
22300 SW BOONES FERRY RD, TUALATIN, OR 97062-7373
(503) 941-3180
Mailing address
7320 SW HUNZIKER RD STE 300, PORTLAND, OR 97223-2302
(503) 941-3033
(503) 747-7013
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
097000577N2NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
237041
—
OR
Enumeration date
06/12/2006
Last updated
03/28/2022
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