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General NPI Number Information
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NPI Number | 1396355913
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Entity Type | Individual
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Provider Name | TIFFANY RUNDE RN
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Gender | Female
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Dates
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Enumeration Date | 08/07/2020
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Last Update Date | 08/07/2020
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Provider Practice Location Address
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Address Line | 24276 AIRPORT RD
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City | EAGLE BUTTE
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State | SD
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Zip | 57625-8021
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Country | US
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Telephone | 605-964-0505
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Fax |
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Provider Business Mailing Address
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Address Line | 1597 CANAL RD
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City | HARTFORD
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State | IL
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Zip | 62048-2949
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Country | US
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Telephone | 618-772-8656
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 2016010593
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License Number State | MO
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