Healthcare Provider Details

I. General information

NPI: 1194979211
Provider Name (Legal Business Name): WANDA G WARNER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5825 AIRLINE HWY
BATON ROUGE LA
70805-2408
US

IV. Provider business mailing address

5825 AIRLINE HWY
BATON ROUGE LA
70805-2408
US

V. Phone/Fax

Practice location:
  • Phone: 225-358-1000
  • Fax:
Mailing address:
  • Phone: 225-358-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP04212
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License NumberAP04212
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN085964
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: