Healthcare Provider Details

I. General information

NPI: 1922957562
Provider Name (Legal Business Name): CAROLYN MARIE WARRICK DDIV, ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2026
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22751 E APPLEWAY AVE # D11
LIBERTY LAKE WA
99019-8511
US

IV. Provider business mailing address

1324 N LIBERTY LAKE RD # 276
LIBERTY LAKE WA
99019-8523
US

V. Phone/Fax

Practice location:
  • Phone: 509-924-6161
  • Fax:
Mailing address:
  • Phone: 509-924-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberAP70085480
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: