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1396772257

NPI Code Detail

MEDICARE: JACQUELINE RENE RUNNER FNP

MEDICARE: JACQUELINE RENE RUNNER FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R111672	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396772257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE RENE RUNNER FNP

Provider Business Mailing Address
First Line	:	2209 DEFENSE HWY
Second Line	:	SUITE C
City	:	CROFTON
State	:	MD
Zip	:	21114-2403
Country	:	US
Telephone Number	:	443-332-4260
Fax Number	:

Provider Business Practice Location Address
First Line	:	2114 GENERALS HWY
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-7488
Country	:	US
Telephone Number	:	888-808-6483
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	11/19/2014

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Directions to “ JACQUELINE RENE RUNNER FNP” Practice Location

Language	Start Address	Practice Location

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