Provider Demographics
NPI:1457596728
Name:RUNGE, KRISTIN M (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:RUNGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 S 86TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9227
Mailing Address - Country:US
Mailing Address - Phone:402-483-7507
Mailing Address - Fax:402-483-6899
Practice Address - Street 1:4545 S 86TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9227
Practice Address - Country:US
Practice Address - Phone:402-483-7507
Practice Address - Fax:402-483-6899
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47068397013Medicaid
NE281775Medicare PIN