Provider Demographics
NPI:1144095142
Name:RUNNELSNP PLLC
Entity type:Organization
Organization Name:RUNNELSNP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:RYLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUNNELS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, FNP-C
Authorized Official - Phone:435-730-3274
Mailing Address - Street 1:3563 W 2425 N
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84404-8577
Mailing Address - Country:US
Mailing Address - Phone:435-730-3274
Mailing Address - Fax:
Practice Address - Street 1:3563 W 2425 N
Practice Address - Street 2:
Practice Address - City:PLAIN CITY
Practice Address - State:UT
Practice Address - Zip Code:84404-8577
Practice Address - Country:US
Practice Address - Phone:435-730-3274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care