Healthcare Provider Details

I. General information

NPI: 1750161832
Provider Name (Legal Business Name): LUCAS JOHN WARNER FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 COURT ST
WEST BRANCH MI
48661-9390
US

IV. Provider business mailing address

640 COURT ST
WEST BRANCH MI
48661-9390
US

V. Phone/Fax

Practice location:
  • Phone: 989-343-3730
  • Fax: 989-343-3733
Mailing address:
  • Phone: 989-343-3730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704322716NSA230AJ
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: