Provider Demographics
NPI:1871528414
Name:FUNARO, NANCY G (NP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:G
Last Name:FUNARO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 PAWTUCKET BOULEVARD - FL 2
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-2042
Mailing Address - Country:US
Mailing Address - Phone:978-970-1607
Mailing Address - Fax:978-970-1115
Practice Address - Street 1:45 PALMER STREET
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852
Practice Address - Country:US
Practice Address - Phone:978-970-1607
Practice Address - Fax:978-970-1115
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA186443363LF0000X
MARN186443363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily