MEDICARE: DIANE ELAINE FUNK NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	71001509A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000864920	OTHER	IN	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	71001509B	OTHER	IN	APN CSR

General Provider Information

NPI Number	:	1396938429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE ELAINE FUNK NP

Provider Business Mailing Address
First Line	:	6100 W 96TH ST
Second Line	:	SUITE 125
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-6005
Country	:	US
Telephone Number	:	317-715-1800
Fax Number	:	317-715-6200

Provider Business Practice Location Address
First Line	:	8301 HARCOURT RD
Second Line	:	RADIATION ONCOLOGY DEPT, STE 100
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-2081
Country	:	US
Telephone Number	:	317-415-6783
Fax Number	:	317-415-6758

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	03/07/2023

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Directions to “ DIANE ELAINE FUNK NP” Practice Location

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