Healthcare Provider Details

I. General information

NPI: 1003596628
Provider Name (Legal Business Name): CHRISTY WARNEKE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 NE 2ND AVE
PORTLAND OR
97232-2003
US

IV. Provider business mailing address

11900 NE 18TH ST APT 278
VANCOUVER WA
98684-4714
US

V. Phone/Fax

Practice location:
  • Phone: 503-944-8000
  • Fax:
Mailing address:
  • Phone: 360-597-8961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number202213317RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: