Marylou Elizabeth Funnell, CHW

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

G-1494 Issued in NM

Practice address

1217 1St St NW
Albuquerque, NM 87102-1529

Phone

(505) 274-1763

NPI assigned

Feb 2, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1706832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706832000000",
    "number": "1386407344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25445",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871250445",
            "telephone_number": "505-274-1763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1217 1ST ST NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871021529",
            "telephone_number": "505-274-1763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNNELL",
        "first_name": "MARYLOU",
        "middle_name": "ELIZABETH",
        "credential": "CHW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-02",
        "last_updated": "2024-02-02",
        "certification_date": "2024-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "NM",
            "license": "G-1494",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Functional Movement LLC
• Functional Orthotics & Prosthetics
• Functional Playground Therapies LLC
• Fundamental Therapy Services LLC
• Erik J. Funk, MD
• Nancie Furgang, MA,OTR
• Mira Furgoch, MS
• Monica Furlong, MD
• Doris W Furr
• Natalie Rose Furst, RDN, LD

• Community Health Worker in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Community Health Worker in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2024; 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.