Provider Demographics
NPI:1710689872
Name:RUNESTAD, OLIS DENISE (APRN, CNP)
Entity Type:Individual
Prefix:MS
First Name:OLIS
Middle Name:DENISE
Last Name:RUNESTAD
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:OLIS
Other - Middle Name:DENISE
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 KISH HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-9602
Mailing Address - Country:US
Mailing Address - Phone:815-766-7334
Mailing Address - Fax:815-766-9768
Practice Address - Street 1:1 KISH HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-9602
Practice Address - Country:US
Practice Address - Phone:815-766-7334
Practice Address - Fax:815-766-9768
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041370130363L00000X
IL209026915363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner