Provider Demographics
NPI:1376950337
Name:FUNK, EKATERINA (CNP)
Entity Type:Individual
Prefix:
First Name:EKATERINA
Middle Name:
Last Name:FUNK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7171
Mailing Address - Country:US
Mailing Address - Phone:207-396-7683
Mailing Address - Fax:207-396-7684
Practice Address - Street 1:100 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7171
Practice Address - Country:US
Practice Address - Phone:207-396-7683
Practice Address - Fax:207-396-7684
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP141064363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily