Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 1-138779 | AL |
NPI | 1003355637 |
---|---|
Provider Name | Rachel Runge |
First Address | Prattville, AL 36066-7290 |
Second Address | Prattville, AL 36066-7290 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2017 |
Last Update Date | 15/02/2017 |