Provider Demographics
NPI:1790112431
Name:RUNYON, MEGAN NICOLE (LPN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:NICOLE
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:PO BOX 25
Mailing Address - Street 2:649 DODGE ST
Mailing Address - City:MINFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45653-0025
Mailing Address - Country:US
Mailing Address - Phone:740-961-3123
Mailing Address - Fax:
Practice Address - Street 1:649 DODGE ST
Practice Address - Street 2:
Practice Address - City:MINFORD
Practice Address - State:OH
Practice Address - Zip Code:45653
Practice Address - Country:US
Practice Address - Phone:740-961-3213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-154184-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse