1487636932 NPI number — MS. ELIZABETH FUNKE GALL R.N., F.N.P.-C.

Table of content: MS. ELIZABETH FUNKE GALL R.N., F.N.P.-C. (NPI 1487636932)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487636932 NPI number — MS. ELIZABETH FUNKE GALL R.N., F.N.P.-C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALL
Provider First Name:
ELIZABETH
Provider Middle Name:
FUNKE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
R.N., F.N.P.-C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FUNKE
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.N., F.N.P.-C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487636932
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2315 STOCKTON BLVD
Provider Second Line Business Mailing Address:
ROOM 1P517 CARDIOLOGY
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95817-2201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-703-6421
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2360 STOCKTON BLVD
Provider Second Line Business Practice Location Address:
HEMOPHILIA TREATMENT CENTER
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95817-2209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-734-7624
Provider Business Practice Location Address Fax Number:
916-734-3951
Provider Enumeration Date:
11/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  413322 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 11294 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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