MEDICARE: NATHANIEL ZACHARIAH RUNCK MA, LBA

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	103K00000X	Behavior Analyst	LBA0880	MN

General Provider Information

NPI Number	:	1235803180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIEL ZACHARIAH RUNCK MA, LBA

Provider Business Mailing Address
First Line	:	816 PORTLAND AVE APT 1316
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-4625
Country	:	US
Telephone Number	:	507-430-9138
Fax Number	:

Provider Business Practice Location Address
First Line	:	816 PORTLAND AVE APT 1316
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-4625
Country	:	US
Telephone Number	:	507-430-9138
Fax Number	:

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

Provider Enumeration Date	:	08/04/2021
Last Update Date	:	01/30/2026

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