Healthcare Provider Details

I. General information

NPI: 1285979518
Provider Name (Legal Business Name): LISA WARNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 EMERALD CIR
DUNDEE MI
48131-2014
US

IV. Provider business mailing address

275 EMERALD CIR
DUNDEE MI
48131-2014
US

V. Phone/Fax

Practice location:
  • Phone: 419-349-5742
  • Fax:
Mailing address:
  • Phone: 419-349-5742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number370387
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704281249
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: