Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 59381 | MN |
NPI | 1003228669 |
---|---|
Provider Name | Emily Funk |
First Address | Minneapolis, MN 55407-1321 |
Second Address | Minneapolis, MN 55407-1321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2014 |
Last Update Date | 11/03/2021 |