Provider Demographics
NPI:1326026824
Name:PRUM, ANDRA L (DO)
Entity type:Individual
Prefix:DR
First Name:ANDRA
Middle Name:L
Last Name:PRUM
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:11700 W CHARLESTON BLVD # 170-597
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1573
Mailing Address - Country:US
Mailing Address - Phone:702-660-2024
Mailing Address - Fax:701-203-9648
Practice Address - Street 1:8905 W POST RD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-2429
Practice Address - Country:US
Practice Address - Phone:702-660-2024
Practice Address - Fax:701-203-9648
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV1123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCS11196OtherPHARMACY/CDS
NVFP2099441OtherDEA