Provider Demographics
NPI:1083091482
Name:RUNYAN, HALLIE (CRNA)
Entity Type:Individual
Prefix:
First Name:HALLIE
Middle Name:
Last Name:RUNYAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10223 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-6304
Mailing Address - Country:US
Mailing Address - Phone:515-537-5521
Mailing Address - Fax:
Practice Address - Street 1:411 LAUREL ST STE 3170
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3005
Practice Address - Country:US
Practice Address - Phone:515-283-0463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD117108367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered