Provider Demographics
NPI:1558640904
Name:MUNNERLYN, ROYALLE K (STNA)
Entity Type:Individual
Prefix:
First Name:ROYALLE
Middle Name:K
Last Name:MUNNERLYN
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1484 ELAINE RD
Mailing Address - Street 2:D
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-2382
Mailing Address - Country:US
Mailing Address - Phone:614-327-1274
Mailing Address - Fax:
Practice Address - Street 1:1484 ELAINE RD
Practice Address - Street 2:D
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227
Practice Address - Country:US
Practice Address - Phone:614-327-1274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400491620505376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide