Provider Demographics
NPI:1235364126
Name:FUNNI, MARCY LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARCY
Middle Name:LYNN
Last Name:FUNNI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 ROSELAWN ST
Mailing Address - Street 2:
Mailing Address - City:WOLVERINE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-1942
Mailing Address - Country:US
Mailing Address - Phone:248-926-6395
Mailing Address - Fax:
Practice Address - Street 1:2351 ROSELAWN ST
Practice Address - Street 2:
Practice Address - City:WOLVERINE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-1942
Practice Address - Country:US
Practice Address - Phone:248-926-6395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703055105164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse