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General NPI Number Information
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NPI Number | 1417602517
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Entity Type | Individual
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Provider Name | TWANA RENEE RUNDLE NP-C
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Gender | Female
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Dates
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Enumeration Date | 02/16/2022
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 1550 BISHOP CT
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City | MOUNT PROSPECT
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State | IL
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Zip | 60056-6039
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Country | US
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Telephone | 312-805-8170
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Fax |
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Provider Business Mailing Address
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Address Line | 408 S EDSON AVE
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City | LOMBARD
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State | IL
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Zip | 60148-2421
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Country | US
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Telephone | 815-545-2851
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.024755
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License Number State | IL
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