Organization
DIABETES FUNDAMENTALS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LACEY FUNAIR MS,RDN,CDCES,BC-ADM (OWNER)
(724) 900-9075
Entity
Organization
Contact information
Practice address
405 HAZEL ST, ZELIENOPLE, PA 16063-1016
(724) 900-9075
(724) 382-7709
Mailing address
405 HAZEL ST, ZELIENOPLE, PA 16063-1016
(724) 900-9075
(724) 382-7709
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
174400000X
Specialist
—
—
174H00000X
Health Educator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1041869230001
—
PA
Enumeration date
06/15/2023
Last updated
06/19/2024
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