Provider Demographics
NPI:1043288327
Name:RUNQUIST, BARBARA J (NP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:RUNQUIST
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:J
Other - Last Name:MAIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 N 12TH ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2848
Mailing Address - Country:US
Mailing Address - Phone:602-839-0265
Mailing Address - Fax:602-839-0270
Practice Address - Street 1:1300 N 12TH ST
Practice Address - Street 2:SUITE 404
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2848
Practice Address - Country:US
Practice Address - Phone:602-839-0265
Practice Address - Fax:602-839-0270
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ096567363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ442278Medicaid
S51690Medicare UPIN
AZ442278Medicaid
AZ120296Medicare PIN
AZ120297Medicare PIN