Provider Demographics
NPI:1073575205
Name:FUNT, NICOLE ELAINE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:ELAINE
Last Name:FUNT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 WASHINGTON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15228-1915
Mailing Address - Country:US
Mailing Address - Phone:412-440-0270
Mailing Address - Fax:412-440-0271
Practice Address - Street 1:660 WASHINGTON RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15228-1915
Practice Address - Country:US
Practice Address - Phone:412-440-0270
Practice Address - Fax:412-440-0271
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003056L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P91276Medicare UPIN
PA096687H2AMedicare ID - Type Unspecified