MRS. DYNATA CHARLES FUNDERBURG (NPI# 1548486152) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548486152 |
| Entity Type | Individual |
| Full Name | MRS. DYNATA CHARLES FUNDERBURG |
| Credential | M.A. |
| Practice Address |
806 Maple Rd Flossmoor IL 60422-1060 |
| Practice Telephone | 7086476426 |
| Practice Fax Number | 7086476233 |
| Mailing Telephone | 7086476426 |
| Mailing Fax Number | 7086476233 |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TM1800X |
Psychologist Specialization: Mental Retardation & Developmental Disabilities |
Behavioral Health & Social Service Providers |
| Street Address |
806 MAPLE RD |
| City | FLOSSMOOR |
| State | IL |
| Zip Code | 60422-1060 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588274310 | Miranda Home Health Care Inc | Nursing Care | 19150 S. Kedzie Ave, 203, Flossmoor, IL 60422 | 2020-08-06 |
| 1285256172 | Bp Behavioral Services, LLC | Behavioral Analyst | 2222 Marston Lane, Flossmoor, IL 60422 | 2020-05-13 |
| 1891164133 | Lauren Simpson | Behavioral Analyst | 19530 Kezie Avenue, Flossmoor, IL 60422 | 2015-09-16 |
| 1437541190 | Keshawn Gardner | Specialist/Technologist, Other | 1248 Berry Ln, Flossmoor, IL 60422 | 2015-03-04 |
| 1770989717 | Naomi Kelly | Behavioral Analyst | 1930 Kedzie Avenue, Flossmoor, IL 60422 | 2014-11-18 |
| 1093059453 | Miranda Home Health Care Inc | In Home Supportive Care | 19150 S Kedzie Ave, 203, Flossmoor, IL 60422 | 2012-11-23 |
| 1285981506 | Restorative Life Services, LLC | Social Worker | 169624 Governors Highway, Flossmoor, IL 60422 | 2012-08-06 |
| 1063786457 | Gwyneeda Carter-sidberry | Pharmacist | 1443 Selkirk Street, Flossmoor, IL 60422 | 2012-03-02 |
| 1053682021 | Alfonso Javier Medina Sr. | Anesthesiology | 3141 Stonegate Ct., Flossmoor, IL 60422 | 2012-01-23 |
| 1912121161 | Anthony J Maoloni | Dentist | 19815 Governors Highway, Orthodontic Associates Ltd Suite 1, Flossmoor, IL 60422 | 2007-04-12 |
| Find all providers in zip 60422 | ||||
| Taxonomy Code | 103TM1800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Mental Retardation & Developmental Disabilities |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194296582 | Joshua E Green | Psychologist | 2721 W Belmont Ave Apt 1, Chicago, IL 60618-5914 | 2018-12-10 |
| 1891205605 | Delorean Mckinney | Psychologist | 4031 Dayton Ave, Mchenry, IL 60050 | 2017-10-06 |
| 1447598305 | Alison Lee May | Psychologist | 4736 Washington St, Skokie, IL 60076-2573 | 2013-01-27 |
| 1477818359 | Susan Elizabeth Reed | Psychologist | 2434 W Byron St, Chicago, IL 60618-3710 | 2012-07-07 |
| 1134392590 | Jennifer Lynne Klapatch | Psychologist | 928 W Eastwood Ave, Chicago, IL 60640-5108 | 2008-04-08 |
| 1285803114 | Michael E May | Psychologist | 208 Breeze St, Carterville, IL 62918-2358 | 2008-02-25 |
| 1386812782 | Vicky James | Psychologist | 11600 Francis Rd, Mokena, IL 60448-2440 | 2008-02-19 |
| 1700054988 | Erika Marie Winston | Psychologist | 3100 S Central Ave, Cicero, IL 60804-3956 | 2008-02-11 |
| 1245411156 | Trista D. Robinson | Psychologist | 100 Forest Pl, Unit P36, Oak Park, IL 60301-1145 | 2007-11-19 |
| 1942489315 | Emily Guinta | Psychologist | 3135 Concord Ln, Wadsworth, IL 60083-8938 | 2007-11-01 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.