Healthcare Provider Details

I. General information

NPI: 1730732140
Provider Name (Legal Business Name): BREANNA MARIE RUNNELLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 SPARKS BLVD
SPARKS NV
89434-2500
US

IV. Provider business mailing address

3785 BAKER LN
RENO NV
89509-5453
US

V. Phone/Fax

Practice location:
  • Phone: 775-560-4825
  • Fax: 844-402-8510
Mailing address:
  • Phone: 775-560-4825
  • Fax: 844-402-8510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA0843
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: