Provider Demographics
NPI:1124784657
Name:FUNK, LYNDSAY LEIGH REBECCA (NP)
Entity type:Individual
Prefix:
First Name:LYNDSAY
Middle Name:LEIGH REBECCA
Last Name:FUNK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7011 MERCURY DR
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-5097
Mailing Address - Country:US
Mailing Address - Phone:928-278-8098
Mailing Address - Fax:
Practice Address - Street 1:5300 S SUTTER DR BLDG A
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-8054
Practice Address - Country:US
Practice Address - Phone:928-362-5258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ263315363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily