Active NPI
Mary Funk, NP
- Nurse Practitioner
- Winona, MN
National Provider Identifier
1780645994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- R0972002
- Practice address
- 859 Mankato Ave
Winona Clinic
Winona, MN 55987 - Phone
- (507) 457-7667
- Fax
- (507) 457-7704
- NPI assigned
- Mar 29, 2006
- Last updated
- Apr 22, 2008
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | R0972002 | MN | Primary |
Addresses
Primary practice location
859 Mankato Ave
Winona Clinic
Winona, MN 55987
Mailing address
859 Mankato Ave
Winona Clinic
Winona, MN 55987
Phone (507) 457-7667
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 103827300 | Medicaid | MN |
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 65775 | MN | MD | Urology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208822400000",
"number": "1780645994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "859 MANKATO AVE",
"address_2": "WINONA CLINIC",
"city": "WINONA",
"state": "MN",
"postal_code": "55987",
"telephone_number": "507-457-7667",
"fax_number": "507-457-7704"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "859 MANKATO AVE",
"address_2": "WINONA CLINIC",
"city": "WINONA",
"state": "MN",
"postal_code": "55987",
"telephone_number": "507-457-7667",
"fax_number": "507-457-7704"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUNK",
"first_name": "MARY",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-29",
"last_updated": "2008-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MN",
"license": "R0972002",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "103827300",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Winona, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.