Healthcare Provider Details

I. General information

NPI: 1487255410
Provider Name (Legal Business Name): ADRIANA CRYSTAL WARNE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4013 E PUEBLO AVE
MESA AZ
85206-5122
US

IV. Provider business mailing address

4013 E PUEBLO AVE
MESA AZ
85206-5122
US

V. Phone/Fax

Practice location:
  • Phone: 480-417-9882
  • Fax:
Mailing address:
  • Phone: 480-417-9882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number255036
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN183717
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: