Individual
MS. ROBERTA ELAINE FUNCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
294 W STATE ROUTE 89A, COTTONWOOD, AZ 86326-3754
(928) 649-7889
Mailing address
1200 N BEAVER ST, PAYER CREDENTIALING, FLAGSTAFF, AZ 86001-3118
(928) 213-6235
(928) 213-6292
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
4341
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
486799
—
AZ
Enumeration date
07/18/2007
Last updated
03/14/2017
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