Provider Demographics
NPI:1386072544
Name:RUNKEL, CYNTHIA ROSE (RN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ROSE
Last Name:RUNKEL
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 1:5058 WOODWAY CT
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-3451
Mailing Address - Country:US
Mailing Address - Phone:716-725-9826
Mailing Address - Fax:
Practice Address - Street 1:5058 WOODWAY CT
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-3451
Practice Address - Country:US
Practice Address - Phone:716-725-9826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-28
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY656961163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse