MEDICARE: KAREN GAYLE RUNKE-PORCELLO PA

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	364SF0001X	Family Health Clinical Nurse Specialist	1594	AZ

General Provider Information

NPI Number	:	1730197740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN GAYLE RUNKE-PORCELLO PA

Provider Business Mailing Address
First Line	:	2445 N HAYDEN RD
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85257-2303
Country	:	US
Telephone Number	:	480-947-3451
Fax Number	:	480-945-7614

Provider Business Practice Location Address
First Line	:	2445 N HAYDEN RD
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85257-2303
Country	:	US
Telephone Number	:	480-947-3451
Fax Number	:	480-945-7614

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	06/30/2010

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