Healthcare Provider Details

I. General information

NPI: 1760567275
Provider Name (Legal Business Name): JACQUELINE CHRISTINE WARNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 12/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 E CUTHBERT BLVD
HADDON TOWNSHIP NJ
08108-2021
US

IV. Provider business mailing address

725 SHROPSHIRE DR
WEST CHESTER PA
19382-2240
US

V. Phone/Fax

Practice location:
  • Phone: 856-833-1164
  • Fax:
Mailing address:
  • Phone: 484-947-5586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA052702
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00248900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: