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General NPI Number Information
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NPI Number | 1972259968
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Entity Type | Individual
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Provider Name | ANDREA LYNN WARNER FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/28/2022
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 408 N 2ND ST
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City | MARSHALL
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State | IL
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Zip | 62441-1010
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Country | US
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Telephone | 217-826-2361
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Fax |
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Provider Business Mailing Address
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Address Line | 13310 N 450TH ST
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City | MARTINSVILLE
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State | IL
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Zip | 62442-2602
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Country | US
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Telephone | 618-928-3517
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.024825
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License Number State | IL
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