| Provider / Organization | NPI | Date Certified |
|---|---|---|
| LACEY FUNAIR | 1811664915 | 2023-05-06 |
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 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,MS,RDN,LDN,CDCES |
| Practice Office Address | 414 HAZEL ST ZELIENOPLE, PA US |
| Practice Office Telephone | 7249009075 |
| Practice Office Fax | 4127853703 |
| Mailing Address | 414 HAZEL ST APT 1 ZELIENOPLE, PA 160631087 US |
| Business Telephone | 7249009075 |
| Business Fax | 4127853703 |
| Code | Practice | License No State |
|---|---|---|
| 133V00000X PRIMARY | Dietary & Nutritional Service Providers Dietitian, Registered Dietitian, Registered All Other Specialties & Provider Types Dietitian, Registered Dietary & Nutritional Service Providers | DN005678
PA |
| 103946426-001 | MEDICAID | PA |