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Individual

MRS. CAROL JEAN FUNCANNON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
301 S STATE ST, UKIAH, CA 95482-4906
(707) 468-9347
Mailing address
301 S STATE ST, UKIAH, CA 95482-4906
(707) 468-9347

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
CA

Other

Enumeration date
09/30/2008
Last updated
09/30/2008
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