Provider Demographics
NPI:1720330087
Name:FUNK, CAROLE KATHLEEN (CNP)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:KATHLEEN
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 1:585 MANOR HILL DR
Mailing Address - Street 2:
Mailing Address - City:TOMS BROOK
Mailing Address - State:VA
Mailing Address - Zip Code:22660-2549
Mailing Address - Country:US
Mailing Address - Phone:540-436-8660
Mailing Address - Fax:
Practice Address - Street 1:2034 PRO POINTE LN
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8021
Practice Address - Country:US
Practice Address - Phone:540-433-1905
Practice Address - Fax:540-433-1906
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170414363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024170414OtherVA LICENSE
VA0024170414OtherVA LICENSE