Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | K112925 | IA |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | K112925 | IA |
NPI | 1174880744 |
---|---|
Provider Name | Jade L Runge |
First Address | Iowa City, IA 52242-1009 |
Second Address | Iowa City, IA 52242-1009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2012 |
Last Update Date | 07/05/2019 |