Individual
MRS. MICHELLE KELLY FUNK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP-BC
Contact information
Practice address
10521 ROSEHAVEN ST, FAIRFAX, VA 22030-2876
(703) 281-5000
Mailing address
8110 MAPLE LAWN BLVD STE 235, FULTON, MD 20759-2694
(301) 340-8339
(301) 340-9027
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
0024181050
VA
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
0024181050
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0024181050
LICENSE
VA
05
—
1588259501
—
VA
Enumeration date
03/02/2021
Last updated
06/19/2023
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