Provider Demographics
NPI:1508330317
Name:FUNCK, JEFFREY MARK (RN)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MARK
Last Name:FUNCK
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-0670
Mailing Address - Country:US
Mailing Address - Phone:810-835-6743
Mailing Address - Fax:800-852-2393
Practice Address - Street 1:G-4443 MILLER ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507
Practice Address - Country:US
Practice Address - Phone:810-244-0038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704235503163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health