Provider Demographics
NPI:1972568285
Name:FUNKE, LAURA A (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:A
Last Name:FUNKE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5949 CAMP RD STE 1004
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4425
Mailing Address - Country:US
Mailing Address - Phone:716-822-2982
Mailing Address - Fax:888-450-4294
Practice Address - Street 1:5949 CAMP RD # 1004
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4425
Practice Address - Country:US
Practice Address - Phone:716-822-2982
Practice Address - Fax:888-450-4294
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332833363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16-1472493OtherTAX ID# FOR EMPLOYER