| NPI | 1235766734 |
|---|---|
| Former Name | ALLIE THERESE FUNKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 101969) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IA 101969) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2022-10-27 |