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NPI Code Detail

MEDICARE: BREANNA MARIE RUNNELLS

MEDICARE: BREANNA MARIE RUNNELLS
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
1103K00000XBehavior AnalystLBA0843NV

General Provider Information

NPI Number : 1730732140
Entity Type Code : Individual
Provider Name (Legal Business Name) : BREANNA MARIE RUNNELLS
Provider Business Mailing Address
First Line : 3785 BAKER LN
Second Line :
City : RENO
State : NV
Zip : 89509-5453
Country : US
Telephone Number : 775-560-4825
Fax Number : 844-402-8510
Provider Business Practice Location Address
First Line : 2301 SPARKS BLVD
Second Line :
City : SPARKS
State : NV
Zip : 89434-2500
Country : US
Telephone Number : 775-560-4825
Fax Number : 844-402-8510
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2019
Last Update Date : 06/16/2026

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Directions to “ BREANNA MARIE RUNNELLS ” Practice Location

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