Healthcare Provider Details

I. General information

NPI: 1689245250
Provider Name (Legal Business Name): LAUREN ELIZABETH WARNEKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 EDMUNDSON PL
COUNCIL BLUFFS IA
51503-4658
US

IV. Provider business mailing address

825 S 169TH ST 3RD FLOOR-SOUTH
OMAHA NE
68118-9300
US

V. Phone/Fax

Practice location:
  • Phone: 712-396-4300
  • Fax:
Mailing address:
  • Phone: 402-354-4822
  • Fax: 402-354-5454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA164218
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: