Healthcare Provider Details

I. General information

NPI: 1437407301
Provider Name (Legal Business Name): JAYANNA WARWICK PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2012
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 WYOMING BLVD NE SUITE F
ALBUQUERQUE NM
87112-2622
US

IV. Provider business mailing address

2015 WYOMING BLVD NE SUITE F
ALBUQUERQUE NM
87112-2622
US

V. Phone/Fax

Practice location:
  • Phone: 505-967-4773
  • Fax: 505-967-4398
Mailing address:
  • Phone: 505-967-4773
  • Fax: 505-967-4398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP02033
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: