Provider Demographics
NPI:1073243713
Name:RUNNEBAUM, TANYA CHRISTINE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:CHRISTINE
Last Name:RUNNEBAUM
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 SE WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66605-2189
Mailing Address - Country:US
Mailing Address - Phone:785-267-0744
Mailing Address - Fax:
Practice Address - Street 1:2909 SE WALNUT DR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66605-2189
Practice Address - Country:US
Practice Address - Phone:785-267-0744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-81160363L00000X, 363L00000X
KS53-81160-062363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care