Provider Demographics
NPI:1447788658
Name:FUNKA, ALISON MARIE (AGNP-C)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:MARIE
Last Name:FUNKA
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 N CENTER RD STE 500
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-7922
Mailing Address - Country:US
Mailing Address - Phone:989-583-3150
Mailing Address - Fax:
Practice Address - Street 1:3400 N CENTER RD STE 500
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-7922
Practice Address - Country:US
Practice Address - Phone:989-583-3150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704271435363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care