Provider Demographics
NPI:1194917666
Name:FUNKHOUSER, LORI (FNP-BC, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:FUNKHOUSER
Suffix:
Gender:F
Credentials:FNP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2980 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1834
Mailing Address - Country:US
Mailing Address - Phone:330-759-0276
Mailing Address - Fax:330-759-0030
Practice Address - Street 1:8577 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2345
Practice Address - Country:US
Practice Address - Phone:330-856-6663
Practice Address - Fax:330-856-1581
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.09522363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2793973Medicaid
OHH095601Medicare PIN