Provider Demographics
NPI:1215754296
Name:RUNYON, LINDA FAYE
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:FAYE
Last Name:RUNYON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 106
Mailing Address - Street 2:
Mailing Address - City:PEDRO
Mailing Address - State:OH
Mailing Address - Zip Code:45659-0106
Mailing Address - Country:US
Mailing Address - Phone:740-302-2756
Mailing Address - Fax:
Practice Address - Street 1:1577 CR 25
Practice Address - Street 2:
Practice Address - City:PEDRO
Practice Address - State:OH
Practice Address - Zip Code:45659
Practice Address - Country:US
Practice Address - Phone:740-532-2398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant