Provider Demographics
NPI:1255078770
Name:RUNCHEY, MARY-CLAIRE (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:MARY-CLAIRE
Middle Name:
Last Name:RUNCHEY
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4842 N KILPATRICK AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1725
Mailing Address - Country:US
Mailing Address - Phone:773-931-7944
Mailing Address - Fax:
Practice Address - Street 1:4842 N KILPATRICK AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1725
Practice Address - Country:US
Practice Address - Phone:773-931-7944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.008724133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered