Individual
TABBATHA ANN RUNNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4430 MISSOURI AVE, FORT LEONARD WOOD, MO 65473-9098
(573) 596-2560
(573) 596-9588
Mailing address
32725 HIGHWAY 17, LAQUEY, MO 65534-7672
(573) 855-5912
(573) 596-9588
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
2012007205
MO
Other
Enumeration date
01/28/2021
Last updated
01/28/2021
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