MEDICARE: GERALDINE RUNYON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife

General Provider Information

NPI Number	:	1205187416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALDINE RUNYON

Provider Business Mailing Address
First Line	:	15 PERIWINKLE LN
Second Line	:
City	:	LONG BEACH
State	:	MS
Zip	:	39560-6364
Country	:	US
Telephone Number	:	228-263-4447
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 PERIWINKLE LN
Second Line	:
City	:	LONG BEACH
State	:	MS
Zip	:	39560-6364
Country	:	US
Telephone Number	:	228-263-4447
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2012
Last Update Date	:	09/27/2012

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Directions to “ GERALDINE RUNYON ” Practice Location

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