| Provider / Organization | NPI | Date Certified |
|---|---|---|
| LACEY FUNAIR | 1811664915 | 2021-08-26 |
Lacey Funair is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1811664915. Registration indicates Lacey Funair is a provider of services with a specialization in Specialist (Other Service Providers, Specialist) (All Other Specialties & Provider Types, ) (Specialist, Other Service Providers) (Other Service Providers, Health Educator) (Health Educator, Other Service Providers) (Health Educator, ) (Dietary & Nutritional Service Providers, Dietitian, Registered) (Dietitian, Registered, ) (All Other Specialties & Provider Types, ) (Dietitian, Registered, Dietary & Nutritional Service Providers)
| Entity Type | Individual |
| Provider Name | Lacey Funair MS,RDN,CDCES,BC-ADM |
| Practice Office Address | 1135 W PORTERSVILLE RD PORTERSVILLE, PA US |
| Practice Office Telephone | 7249009075 |
| Practice Office Fax | 7243827709 |
| Mailing Address | 1135 W PORTERSVILLE RD PORTERSVILLE, PA 160512313 US |
| Business Telephone | 7249009075 |
| Business Fax | 7243827709 |
| Code | Practice | License No State |
|---|---|---|
| 174400000X | Specialist Other Service Providers Specialist All Other Specialties & Provider Types Specialist Other Service Providers | CBDCE22200462
|
| 174H00000X | Other Service Providers Health Educator Health Educator Other Service Providers Health Educator | |
| 133V00000X PRIMARY | Dietary & Nutritional Service Providers Dietitian, Registered Dietitian, Registered All Other Specialties & Provider Types Dietitian, Registered Dietary & Nutritional Service Providers | DN005678
PA |
| 1039464260002 | MEDICAID | PA |