Provider Demographics
NPI:1962844811
Name:RUNKLE, KENNETH A (LPN)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:A
Last Name:RUNKLE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 MARSEILLES GALION RD E
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-9736
Mailing Address - Country:US
Mailing Address - Phone:614-832-5033
Mailing Address - Fax:
Practice Address - Street 1:648 MARSEILLES GALION RD E
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-9736
Practice Address - Country:US
Practice Address - Phone:614-832-5033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.153353-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse