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NPI Code Detail

MEDICARE: NANCY WARDEN MD

MEDICARE: NANCY WARDEN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianG47331CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100G473310OTHERCAMEDICAL NUMBER

General Provider Information

NPI Number : 1093790305
Entity Type Code : Individual
Provider Name (Legal Business Name) : NANCY WARDEN MD
Provider Business Mailing Address
First Line : PO BOX 1340
Second Line :
City : SHINGLE SPRINGS
State : CA
Zip : 95682-1340
Country : US
Telephone Number : 530-387-8011
Fax Number : 530-672-1507
Provider Business Practice Location Address
First Line : 5168 HONPIE RD
Second Line :
City : PLACERVILLE
State : CA
Zip : 95667-8682
Country : US
Telephone Number : 530-387-4321
Fax Number : 530-672-1507
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2005
Last Update Date : 09/16/2024

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