Individual
MARILEE KRISTINEA FAIRCLOTH RUNGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN
Contact information
Practice address
3333 SILAS CREEK PARKWAY, WINSTON-SALEM, NC 27103-3099
(336) 718-8278
(336) 718-9271
Mailing address
2085 FRONTIS PLAZA, WINSTON-SALEM, NC 27103-5614
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
152495
NC
Other
Enumeration date
10/15/2010
Last updated
12/15/2010
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