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General NPI Number Information
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NPI Number | 1538798707
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Entity Type | Individual
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Provider Name | MADELINE RUNYAN RDN, LDN
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Gender | Female
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Dates
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Enumeration Date | 04/08/2020
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Last Update Date | 06/28/2022
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Provider Practice Location Address
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Address Line | 1 CHILDRENS PLZ
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City | DAYTON
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State | OH
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Zip | 45404-1815
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Country | US
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Telephone | 937-641-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 166 MADISON AVE
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City | URBANA
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State | OH
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Zip | 43078-1454
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Country | US
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Telephone | 937-508-7544
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | LD.09087
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License Number State | OH
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