Provider Demographics
NPI:1144342536
Name:FUNNELL, MARY BETH (RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:FUNNELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BETH
Other - Last Name:FUNNELL-MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:22800 N 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-4235
Mailing Address - Country:US
Mailing Address - Phone:623-376-3000
Mailing Address - Fax:623-376-3080
Practice Address - Street 1:22800 N 67TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-4235
Practice Address - Country:US
Practice Address - Phone:623-376-3000
Practice Address - Fax:623-376-3080
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN032074163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool