| NPI | 1750990222 |
|---|---|
| Former Name | THERESA MARIE FUNK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: WI 123093-30) |
| Enumeration Date | 2020-07-30 |
| Last Update Date | 2020-07-30 |