John A Pru, CRNA
Individual provider Active NPI Certified Registered Nurse Anesthetist · Alta, WY
NPI 1093771503 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1093771503
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- 6780.0512 (WY)
- Practice address
- 80 Perimeter Drive
Alta, WY 83414 - Phone
- (307) 421-3396
- NPI assigned
- Apr 24, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 17
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Registered Nurse, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 575191 | TX | MD | Neurology Physician |
| 136276 | NC | MD | Diagnostic Radiology Physician |
| 6780.0512 | WY | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jennifer Sassi PA | Nurse Anesthetist, Certified Registered | Past |
Accepting new patients |
| Augusta University | Past | Accepting new patients | |
| Mercy Tyler Health Systems | Past | Accepting new patients | |
| Medical Center Anesthesiology of Athens | Past | Accepting new patients | |
| Roswell Clinic Corp | Past | Accepting new patients | |
| Mercy Tyler Hospital | Past | Accepting new patients | |
| Ridgecrest Regional Hospital | Past | Accepting new patients | |
| Nurse Anesthesia of North Carolina, PLLC | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
| The Stingl Family Foundation, Inc | Past |
Accepting new patients | |
| Medical Anesthesia and Pain Management Consultants, P.a. | Past |
Accepting new patients | |
| Collier Anesthesia PA | Past | Accepting new patients | |
| Anesthesia Partners, LTD. | Past | Accepting new patients | |
| Anesthesia Associates of Easton, P C | Past | Accepting new patients | |
| Wa Spok DH Crna LLC | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
| Anesthesia Associates, PS | Past | Accepting new patients | |
| Brevard Anesthesia Services PA | Nurse Anesthetist, Certified Registered | Past |
Accepting new patients |
| Zanesville Anesthesia Physicians Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 6780.0512 | WY | Yes |
Addresses
Primary practice location
80 Perimeter Drive
Alta, WY 83414
Mailing address
PO Box 563
Alta, WY 83414
Phone (307) 421-3396
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 016358 | Other | COUNCIL OF RECERT. ON NA |
NPI Registry JSON
{
"created_epoch": "1145836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1093771503",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 563",
"city": "ALTA",
"state": "WY",
"postal_code": "83414",
"telephone_number": "307-421-3396"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "80 PERIMETER DRIVE",
"city": "ALTA",
"state": "WY",
"postal_code": "83414",
"telephone_number": "307-421-3396"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRU",
"first_name": "JOHN",
"middle_name": "A",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "WY",
"license": "6780.0512",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COUNCIL OF RECERT. ON NA",
"identifier": "016358",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Alta, WY
All providers in Alta, WY · Certified Registered Nurse Anesthetist in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.