Functional Medicine of Nevada PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

FUNCTIONAL MEDICINE OF NEVADA PLLC

Practice address

6490 S McCarran Blvd Ste 16
Reno, NV 89509-6165

Phone

(208) 385-7711

NPI assigned

Feb 17, 2021

Organization subpart

Yes

Parent organization

FUNCTIONAL MEDICINE OF IDAHO PCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sam Warren

Title

Ceo

Phone

(208) 385-7711

Specialties & licenses 1

Addresses

Part of

Functional Medicine of Id

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613520000000",
    "number": "1003409319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3858 N GARDEN CENTER WAY STE 100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837035008",
            "telephone_number": "208-385-7711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6490 S MCCARRAN BLVD STE 16",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895096165",
            "telephone_number": "208-385-7711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL MEDICINE OF NEVADA PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FUNCTIONAL MEDICINE OF IDAHO PC",
        "enumeration_date": "2021-02-17",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "status": "A",
        "authorized_official_last_name": "WARREN",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-385-7711"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maxwell Richard Fuller
• Spencer Fuller, MD, MPH
• Brendan Rice Fulmer, MD
• Dara Fulstone
• Functional Fitness LLC
• Stephanie Funderburk
• Tatum Funderburk
• Adele D. Fung, MD
• Brian Y Fung, M.D.
• Vika Kalehua Fungavaka

• Family Medicine Physician in Reno, NV
• Providers in Reno, NV by specialty
• Family Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.