Active NPI
Michelle Lynn Funderburg, BSN, RN
- Administrator Registered Nurse
- Tigard, OR
National Provider Identifier
1407690944
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Administrator Registered Nurse
- License
- 45697
- Practice address
- 7632 SW Durham Rd Ste 105
Tigard, OR 97224-7597 - Phone
- (208) 520-8839
- NPI assigned
- Jun 20, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Administrator Registered Nurse | 163WA2000X | 45697 | ID | Primary |
Addresses
Primary practice location
7632 SW Durham Rd Ste 105
Tigard, OR 97224-7597
Mailing address
9593 W Montebello Dr
Boise, ID 83709-6692
Phone (208) 520-8839
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor on Science - Nursing, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 45697 | ID | MD | Administrator Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1718841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718841600000",
"number": "1407690944",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9593 W MONTEBELLO DR",
"city": "BOISE",
"state": "ID",
"postal_code": "837096692",
"telephone_number": "208-520-8839"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7632 SW DURHAM RD STE 105",
"city": "TIGARD",
"state": "OR",
"postal_code": "972247597",
"telephone_number": "208-520-8839"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUNDERBURG",
"first_name": "MICHELLE",
"middle_name": "LYNN",
"credential": "BSN, RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-06-20",
"last_updated": "2024-06-20",
"certification_date": "2024-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "163WA2000X",
"taxonomy_group": "",
"desc": "Registered Nurse, Administrator",
"state": "ID",
"license": "45697",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tigard, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 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.