Provider Demographics
NPI:1417250796
Name:FUNK, DONNA MARGARET (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MARGARET
Last Name:FUNK
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:3425 ENSIGN RD. NE SUITE 310
Mailing Address - Street 2:SOUTH SOUND ORAL SURGERY ENSIGN MEDICAL CENTER
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506
Mailing Address - Country:US
Mailing Address - Phone:360-456-5678
Mailing Address - Fax:360-456-1238
Practice Address - Street 1:3425 ENSIGN RD. NE SUITE 310
Practice Address - Street 2:SOUTH SOUND ORAL SURGERY ENSIGN MEDICAL CENTER
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-456-5678
Practice Address - Fax:360-456-1238
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WA027975CRNARN00098041367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered