Provider Demographics
NPI:1679690515
Name:RUNYON, JAMIE JO (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:JO
Last Name:RUNYON
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 1:309 THERESA LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-4843
Mailing Address - Country:US
Mailing Address - Phone:765-965-6062
Mailing Address - Fax:
Practice Address - Street 1:309 THERESA LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-4843
Practice Address - Country:US
Practice Address - Phone:765-965-6062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27051183A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse