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General NPI Number Information
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NPI Number | 1144777814
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Entity Type | Individual
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Provider Name | AMANDA M WARNEKE
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Gender | Female
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Dates
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Enumeration Date | 09/09/2016
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Last Update Date | 09/09/2016
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Provider Practice Location Address
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Address Line | 4100 FAIRWAY DR SUITE 100
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City | CARROLLTON
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State | TX
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Zip | 75010-6525
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Country | US
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Telephone | 844-434-7627
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Fax |
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Provider Business Mailing Address
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Address Line | 5411 RICHMOND AVE
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City | DALLAS
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State | TX
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Zip | 75206-7149
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Country | US
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Telephone | 214-564-8470
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA10704
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License Number State | TX
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