Provider Demographics
NPI:1255170130
Name:RUNNINGWOLF, BRANDY ELIZABETH
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:ELIZABETH
Last Name:RUNNINGWOLF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:TOME
Mailing Address - State:NM
Mailing Address - Zip Code:87060-0007
Mailing Address - Country:US
Mailing Address - Phone:505-620-6840
Mailing Address - Fax:
Practice Address - Street 1:10401 RESEARCH RD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-3423
Practice Address - Country:US
Practice Address - Phone:505-620-6840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist