Healthcare Provider Details

I. General information

NPI: 1316469067
Provider Name (Legal Business Name): AMBER EMERSON RUNGE AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NE 10TH ST STE 4C
OKLAHOMA CITY OK
73104-5417
US

IV. Provider business mailing address

800 STANATON L. YOUNG BLVD, STE 1400 ANDREWS ACADEMIC TOWER
OKLAHOMA CITY OK
73014
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-1368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number4751
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: