Healthcare Provider Details

I. General information

NPI: 1225545973
Provider Name (Legal Business Name): ANDREA J WARNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 01/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5651 S WATCHWOOD DR APT 31
TAYLORSVILLE UT
84129-3830
US

IV. Provider business mailing address

5651 S WATCHWOOD DR APT 31
TAYLORSVILLE UT
84129-3830
US

V. Phone/Fax

Practice location:
  • Phone: 801-623-2198
  • Fax:
Mailing address:
  • Phone: 801-623-2198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number195639-3102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: