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General NPI Number Information
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NPI Number | 1982926739
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Entity Type | Individual
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Provider Name | AMBER L RUNSICK RD
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Gender | Female
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Dates
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Enumeration Date | 02/22/2010
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Last Update Date | 07/05/2019
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Provider Practice Location Address
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Address Line | 233 WHITE OAK DR
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City | SALESVILLE
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State | AR
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Zip | 72653-9372
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Country | US
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Telephone | 870-404-6931
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Fax |
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Provider Business Mailing Address
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Address Line | 624 HOSPITAL DR
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653-2955
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Country | US
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Telephone | 870-424-1424
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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 | 1850
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License Number State | AR
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