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NPI Code Detail

MEDICARE: MELINDA LOUISE FUNK FNP

MEDICARE: MELINDA LOUISE FUNK FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner11402CA

General Provider Information

NPI Number : 1679560346
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELINDA LOUISE FUNK FNP
Provider Business Mailing Address
First Line : 742 W HIGHLAND AVE
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92405-3839
Country : US
Telephone Number : 909-881-7320
Fax Number :
Provider Business Practice Location Address
First Line : 742 W HIGHLAND AVE
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92405-3839
Country : US
Telephone Number : 909-881-7320
Fax Number : 909-881-7330
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2005
Last Update Date : 04/29/2022

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Directions to “ MELINDA LOUISE FUNK FNP” Practice Location

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