Provider Demographics
NPI:1972477263
Name:PRUCE, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:PRUCE
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5750
Mailing Address - Country:US
Mailing Address - Phone:607-274-2255
Mailing Address - Fax:607-327-5927
Practice Address - Street 1:520 HUDSON ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5750
Practice Address - Country:US
Practice Address - Phone:607-274-2255
Practice Address - Fax:607-327-5927
Is Sole Proprietor?:No
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY793271163WP0200X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WP0200XNursing Service ProvidersRegistered NursePediatrics