Individual
JACQUELINE RENE RUNNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2114 GENERALS HWY, ANNAPOLIS, MD 21401-7488
(888) 808-6483
Mailing address
2209 DEFENSE HWY, SUITE C, CROFTON, MD 21114-2403
(443) 332-4260
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R111672
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010188652
—
VA
05
—
010188695
—
VA
05
—
010188733
—
VA
05
—
010188768
—
VA
05
—
255202700
—
MD
Enumeration date
06/27/2006
Last updated
11/19/2014
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