Healthcare Provider Details

I. General information

NPI: 1366368383
Provider Name (Legal Business Name): CASEY JO RUNCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 RESERVOIR RD NW
WASHINGTON DC
20007-2111
US

IV. Provider business mailing address

7110 KINSDALE CT
SPRINGFIELD VA
22150-4428
US

V. Phone/Fax

Practice location:
  • Phone: 202-687-4221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN500340055
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: