Organization
ACA CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREA ANDERSON PRUITT DNP (NURSE PRACTITIONER)
(225) 284-7158
Entity
Organization
Contact information
Practice address
23823 EDEN ST, PLAQUEMINE, LA 70764-3315
(225) 284-7158
Mailing address
59185 POSTELL AVE, PLAQUEMINE, LA 70764-3462
(225) 284-7158
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2384201
—
LA
Enumeration date
06/12/2018
Last updated
11/11/2019
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