Provider Demographics
NPI:1801114905
Name:NELMS, JOANNA MARLISS FUNK (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:MARLISS FUNK
Last Name:NELMS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:JOANNA
Other - Middle Name:MARLISS
Other - Last Name:FUNK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:WILFORD HALL AMBULATORY CENTER
Mailing Address - Street 2:1100 WILFORD HALL LOOP
Mailing Address - City:JBSA-LACKLAND AFB
Mailing Address - State:TX
Mailing Address - Zip Code:78236-4660
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WILFORD HALL AMBULATORY CENTER
Practice Address - Street 2:1100 WILFORD HALL LOOP
Practice Address - City:JBSA-LACKLAND AFB
Practice Address - State:TX
Practice Address - Zip Code:78236-4660
Practice Address - Country:US
Practice Address - Phone:210-292-3209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070440A2083A0100X, 2083P0500X
TXT45642083P0500X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine