Individual
ELLA LOUISE FUNKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CAA
Contact information
Practice address
1701 N SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(317) 274-0275
Mailing address
950 N MERIDIAN ST, INDIANAPOLIS, IN 46204-1077
(317) 963-4142
(317) 963-3675
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
75000171A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1103821246
ANTHEM PTAN
IN
Enumeration date
02/06/2024
Last updated
12/03/2024
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