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General NPI Number Information
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NPI Number | 1336667070
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Entity Type | Individual
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Provider Name | TATANISHA FUNCHES
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Gender | Female
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Dates
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Enumeration Date | 09/01/2017
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 2504 WASHINGTON ST STE 102
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City | WAUKEGAN
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State | IL
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Zip | 60085-4960
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Country | US
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Telephone | 847-623-7590
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Fax | 847-623-7591
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Provider Business Mailing Address
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Address Line | 125 S WACKER DR STE 475
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City | CHICAGO
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State | IL
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Zip | 60606-4438
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Country | US
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Telephone | 312-416-3804
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 041380097
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209029247
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License Number State | IL
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