Provider Demographics
NPI:1427784255
Name:RUNOLFSON, AMIE (RN, BSN)
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:RUNOLFSON
Suffix:
Gender:F
Credentials:RN, BSN
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 286
Mailing Address - Street 2:
Mailing Address - City:MANTI
Mailing Address - State:UT
Mailing Address - Zip Code:84642-0286
Mailing Address - Country:US
Mailing Address - Phone:801-234-9722
Mailing Address - Fax:877-586-1196
Practice Address - Street 1:050 S 1500 W
Practice Address - Street 2:
Practice Address - City:MANTI
Practice Address - State:UT
Practice Address - Zip Code:84642
Practice Address - Country:US
Practice Address - Phone:801-234-9722
Practice Address - Fax:877-586-1196
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care