Healthcare Provider Details

I. General information

NPI: 1396466298
Provider Name (Legal Business Name): JACQUELINE A WARMKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE A HAWK

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 PENNSYLVANIA AVE STE 402
CHARLESTON WV
25302-3390
US

IV. Provider business mailing address

97 GREAT TEAYS BLVD STE 6
SCOTT DEPOT WV
25560-9816
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-6999
  • Fax:
Mailing address:
  • Phone: 304-757-6999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0019535
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: