Individual
LACEY FUNAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,RDN,CDCES,BC-ADM
Contact information
Practice address
405 HAZEL ST, ZELIENOPLE, PA 16063-1016
(724) 900-9075
(724) 382-7709
Mailing address
405 HAZEL ST, ZELIENOPLE, PA 16063-1016
(724) 900-9075
(724) 382-7709
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DN005678
PA
174400000X
Specialist
BCADM200914796
—
174400000X
Specialist
CBDCE22200462
—
174H00000X
Health Educator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1039464260002
—
PA
Enumeration date
08/26/2021
Last updated
06/19/2024
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