Healthcare Provider Details

I. General information

NPI: 1346144631
Provider Name (Legal Business Name): MARQUEL TRE WARNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N WASHINGTON AVE STE A
ROSWELL NM
88201-8222
US

IV. Provider business mailing address

216 E CONNER ST
ROSWELL NM
88203-5908
US

V. Phone/Fax

Practice location:
  • Phone: 575-815-9540
  • Fax:
Mailing address:
  • Phone: 575-815-9540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: