Provider Demographics
NPI:1528672979
Name:FUNKE, MELANIE (CNP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:FUNKE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-2865
Mailing Address - Country:US
Mailing Address - Phone:406-449-5796
Mailing Address - Fax:406-449-5371
Practice Address - Street 1:501 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-2865
Practice Address - Country:US
Practice Address - Phone:406-449-5796
Practice Address - Fax:406-449-5371
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT161103363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily