Healthcare Provider Details

I. General information

NPI: 1811993298
Provider Name (Legal Business Name): CATRINA M. FUNK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4234
US

IV. Provider business mailing address

315 MARTIN LUTHER KING JR WAY PO BOX 5299 MS 315-C2-CM
TACOMA WA
98405-4234
US

V. Phone/Fax

Practice location:
  • Phone: 253-403-7518
  • Fax: 253-403-4393
Mailing address:
  • Phone: 253-403-7518
  • Fax: 253-403-4393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD00047923
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: