Provider Demographics
NPI:1568448298
Name:RUNG, NANCY S (DPM)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:S
Last Name:RUNG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-2640
Mailing Address - Country:US
Mailing Address - Phone:440-593-3444
Mailing Address - Fax:440-593-6183
Practice Address - Street 1:219 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2640
Practice Address - Country:US
Practice Address - Phone:440-593-3444
Practice Address - Fax:440-593-6183
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36 00 1826 R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0337988Medicaid
OH0337988Medicaid
OHT08443Medicare UPIN
OH0659880001Medicare NSC
OH0438641Medicare ID - Type Unspecified