Individual
NICOLE MARIE FUNK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
875 S VANGUARD WAY, MERIDIAN, ID 83642-8540
(208) 463-3000
Mailing address
215 E HAWAII AVE, NAMPA, ID 83686-6011
(208) 463-3244
(208) 463-3388
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA-1843
CA
363A00000X
Physician Assistant
PA-1843
ID
363AS0400X
Surgical Physician Assistant
Primary
PA-1843
ID
Other
Enumeration date
01/16/2020
Last updated
11/01/2023
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