Healthcare Provider Details

I. General information

NPI: 1528164688
Provider Name (Legal Business Name): SUSAN J WARNER-OBERWORTMANN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WILLIAM NORTHERN BLVD
TULLAHOMA TN
37388-4754
US

IV. Provider business mailing address

100 WILLIAM NORTHERN BLVD
TULLAHOMA TN
37388-4754
US

V. Phone/Fax

Practice location:
  • Phone: 931-454-0489
  • Fax: 931-454-2348
Mailing address:
  • Phone: 931-454-0489
  • Fax: 931-454-2348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN 06621
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: