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General NPI Number Information
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NPI Number | 1598370553
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Entity Type | Individual
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Provider Name | OLIVIA COLLEEN JAMES FUNK PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 5 CARDARAS DR
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City | GLOUSTER
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State | OH
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Zip | 45732-8011
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Country | US
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Telephone | 740-767-3525
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Fax | 740-767-4046
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Provider Business Mailing Address
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Address Line | PO BOX 7527
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City | DUBLIN
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State | OH
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Zip | 43017-0727
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Country | US
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Telephone |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 50.006647RX
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License Number State | OH
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