MEDICARE: LEXINE FUNSTON A.R.N.P.

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	363LA2200X	Adult Health Nurse Practitioner	AP30006045	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912930603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEXINE FUNSTON A.R.N.P.

Provider Business Mailing Address
First Line	:	PO BOX 850
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-0146
Country	:	US
Telephone Number	:	360-565-9240
Fax Number	:	360-565-9241

Provider Business Practice Location Address
First Line	:	823 GEORGIANA STREET
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-0146
Country	:	US
Telephone Number	:	360-457-4496
Fax Number	:	360-457-2181

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	07/08/2007

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