Provider Demographics
NPI:1821372764
Name:RUNGE, KAREN JOAN (CNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JOAN
Last Name:RUNGE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MILLER
Mailing Address - State:SD
Mailing Address - Zip Code:57362-1238
Mailing Address - Country:US
Mailing Address - Phone:605-853-0158
Mailing Address - Fax:605-853-3885
Practice Address - Street 1:300 W 5TH ST
Practice Address - Street 2:
Practice Address - City:MILLER
Practice Address - State:SD
Practice Address - Zip Code:57362-1238
Practice Address - Country:US
Practice Address - Phone:605-853-0158
Practice Address - Fax:605-853-3885
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000670363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6836400Medicaid
SDS105362Medicare PIN