Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 637 | CT |
NPI | 1043781487 |
---|---|
Provider Name | Dr. Shannon Funkhouser |
First Address | Glastonbury, CT 06033-1806 |
Second Address | Glastonbury, CT 06033-1806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2018 |
Last Update Date | 11/12/2018 |