Provider Demographics
NPI:1699052241
Name:PRUDEN, JOANNE MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:MARIE
Last Name:PRUDEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:PAINTED POST
Mailing Address - State:NY
Mailing Address - Zip Code:14870-1100
Mailing Address - Country:US
Mailing Address - Phone:607-654-2782
Mailing Address - Fax:607-654-2789
Practice Address - Street 1:165 CHARLES ST
Practice Address - Street 2:
Practice Address - City:PAINTED POST
Practice Address - State:NY
Practice Address - Zip Code:14870-1100
Practice Address - Country:US
Practice Address - Phone:607-654-2782
Practice Address - Fax:607-654-2789
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338952-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool