Provider Demographics
NPI:1326184326
Name:RUNGE, DIANE SHARON (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:SHARON
Last Name:RUNGE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W6849 CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WAUSAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:54177-8956
Mailing Address - Country:US
Mailing Address - Phone:715-854-2447
Mailing Address - Fax:
Practice Address - Street 1:W6849 CREEK RD
Practice Address - Street 2:
Practice Address - City:WAUSAUKEE
Practice Address - State:WI
Practice Address - Zip Code:54177-8956
Practice Address - Country:US
Practice Address - Phone:715-854-2447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33560-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse