Healthcare Provider Details

I. General information

NPI: 1467581629
Provider Name (Legal Business Name): NANCY GAIL RUNTON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 HAMAKER CT SUITE 200
FAIRFAX VA
22031-2238
US

IV. Provider business mailing address

10 E CHAPMAN ST
ALEXANDRIA VA
22301-2202
US

V. Phone/Fax

Practice location:
  • Phone: 703-573-2432
  • Fax: 703-280-9350
Mailing address:
  • Phone: 703-549-2448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024070590
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: