Individual
TIMOTHY D FUNDENBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1209 NW NORTH RIDGE DR STE B, ANESTHESIA SERVICES OF BLUE SPRINGS, BLUE SPRINGS, MO 64015-6320
(816) 988-8415
(816) 988-8395
Mailing address
1209 NW NORTH RIDGE DR STE B, ANESTHESIA SERVICES OF BLUE SPRINGS, BLUE SPRINGS, MO 64015-6320
(816) 988-8415
(816) 988-8395
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
131800
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
918702523
—
MO
Enumeration date
09/26/2006
Last updated
01/20/2014
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