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General NPI Number Information
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NPI Number | 1811664915
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Entity Type | Individual
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Provider Name | LACEY FUNAIR MS,RDN,CDCES,BC-ADM
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Gender | Female
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 06/19/2024
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Provider Practice Location Address
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Address Line | 405 HAZEL ST
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City | ZELIENOPLE
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State | PA
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Zip | 16063-1016
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Country | US
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Telephone | 724-900-9075
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Fax | 724-382-7709
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Provider Business Mailing Address
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Address Line | 405 HAZEL ST
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City | ZELIENOPLE
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State | PA
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Zip | 16063-1016
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Country | US
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Telephone | 724-900-9075
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Fax | 724-382-7709
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | CBDCE22200462
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | BCADM200914796
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License Number State |
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Taxonomy #3
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DN005678
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License Number State | PA
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