Healthcare Provider Details

I. General information

NPI: 1316146772
Provider Name (Legal Business Name): JANICE LYNN RUNZHEIMER RN, MSN, PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PENNSYLVANIA AVE
FORT WORTH TX
76104-2122
US

IV. Provider business mailing address

1301 PENNSYLVANIA AVE
FORT WORTH TX
76104-2122
US

V. Phone/Fax

Practice location:
  • Phone: 817-820-4906
  • Fax: 817-250-5441
Mailing address:
  • Phone: 817-820-4906
  • Fax: 817-250-5441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number451365
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number451365
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: