Provider Demographics
NPI:1235845272
Name:RUNGE, JENNIFER RENA (FNP-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RENA
Last Name:RUNGE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 BACK NINE CIR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-7624
Mailing Address - Country:US
Mailing Address - Phone:910-578-3431
Mailing Address - Fax:
Practice Address - Street 1:3008 BACK NINE CIR
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-7624
Practice Address - Country:US
Practice Address - Phone:910-578-3431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSTMP-161262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily