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1144970575 NPI number — JULIE ANN FUNFROCK DO

NPI Number: 1144970575
Health Care Provider/Practitioner: JULIE ANN FUNFROCK DO

Information about “1144970575” NPI (JULIE ANN FUNFROCK DO) exists in 1144970575 in HTML format HTML  |  1144970575 in plain Text format TXT  |  1144970575 in PDF (Portable Document Format) PDF  |  1144970575 in an XML format XML  formats.

NPI Number : 1144970575 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1144970575",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FUNFROCK",
    "FirstName": "JULIE",
    "MiddleName": "ANN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DO",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WEILBAKER",
    "OtherFirstName": "JULIE",
    "OtherMiddleName": "ANN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "10050 AUBURN PARK DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FORT WAYNE",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "46825-2389",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "260-432-6459",
    "MailingAddressFaxNumber": "260-240-5284",
    "FirstLinePracticeLocationAddress": "10050 AUBURN PARK DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FORT WAYNE",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46825-2389",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "260-432-6459",
    "PracticeLocationAddressFaxNumber": "260-240-5284",
    "EnumerationDate": "03/28/2022",
    "LastUpdateDate": "06/26/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "TL.0009112",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": "TL.0009112",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "02008137A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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