Provider Demographics
NPI:1245585983
Name:FUNK, RUTH A
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:A
Last Name:FUNK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47371-1701
Mailing Address - Country:US
Mailing Address - Phone:260-766-4199
Mailing Address - Fax:
Practice Address - Street 1:144 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:IN
Practice Address - Zip Code:47371-1701
Practice Address - Country:US
Practice Address - Phone:260-766-4199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker