Individual
MASHALA MONEA RUNYON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1407 MALLARD, MAGNOLIA, AR 71753-9710
(870) 562-1931
Mailing address
615 E MCNEIL, MAGNOLIA, AR 71753-3061
(870) 949-4544
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6047935001
—
AR
Enumeration date
11/20/2012
Last updated
11/20/2012
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