Provider Demographics
NPI:1780981639
Name:RUNELS, VIJA HOLLEY (RN)
Entity type:Individual
Prefix:MRS
First Name:VIJA
Middle Name:HOLLEY
Last Name:RUNELS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 VIRGINIA TRL
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-5279
Mailing Address - Country:US
Mailing Address - Phone:678-492-8547
Mailing Address - Fax:
Practice Address - Street 1:243 VIRGINIA TRL
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-5279
Practice Address - Country:US
Practice Address - Phone:678-492-8547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN089830163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice