Provider Demographics
NPI:1184364085
Name:RUNYON, LAQUETTA LYNN (LPN)
Entity type:Individual
Prefix:
First Name:LAQUETTA
Middle Name:LYNN
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 1:1609 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-3006
Mailing Address - Country:US
Mailing Address - Phone:304-235-0026
Mailing Address - Fax:304-235-0028
Practice Address - Street 1:1609 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3006
Practice Address - Country:US
Practice Address - Phone:304-235-0026
Practice Address - Fax:304-235-0028
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2053588164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse