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Individual

MS. SUSAN MARY RUNYAN

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
REGISTERED DIETITIAN

Contact information

Practice address
354TH MEDICAL GROUP, 2630 CENTRAL AVE, SUITE 1M07, EIELSON AFB, AK 99702
(907) 377-6662
(907) 377-1629
Mailing address
2594 CARRIE LYNN DR, NORTH POLE, AK 99705-5639
(907) 488-2968

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
110
AK

Other

Enumeration date
03/27/2006
Last updated
07/08/2007
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