Provider Demographics
NPI:1760418263
Name:FUNKE, DONNA JEAN (CRNA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
Last Name:FUNKE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2653 YELLOWWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5561
Mailing Address - Country:US
Mailing Address - Phone:818-879-0791
Mailing Address - Fax:503-372-2754
Practice Address - Street 1:2653 YELLOWWOOD DR
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-5561
Practice Address - Country:US
Practice Address - Phone:818-879-0791
Practice Address - Fax:503-372-2754
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA2179367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNA2179AMedicare ID - Type Unspecified