Healthcare Provider Details

I. General information

NPI: 1487564472
Provider Name (Legal Business Name): EMMA WARNEKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 S MAIN ST
TOOELE UT
84074-2163
US

IV. Provider business mailing address

4519 W 3805 S
WEST VALLEY UT
84120-3717
US

V. Phone/Fax

Practice location:
  • Phone: 435-255-6150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13694350-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: