Provider Demographics
NPI:1285244236
Name:RUNYON, JAMIE E
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:E
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 1:1808 MARCUM TER
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-1465
Mailing Address - Country:US
Mailing Address - Phone:304-429-9056
Mailing Address - Fax:
Practice Address - Street 1:1808 MARCUM TER
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-1465
Practice Address - Country:US
Practice Address - Phone:304-429-9056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant