Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | APN2326 | SC |
Y | 363LA2100X | Nurse Practitioner - Acute Care | 2326 | SC |
NPI | 1033114087 |
---|---|
Provider Name | Susan L Funk |
First Address | Greenville, SC 29601-2842 |
Second Address | Greenville, SC 29615-4816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 30/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NP0244 | (05) | SC |
S66171 | (02) | SC |