MEDICARE: MILTONIA ANTOINETTE WARNER

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
1	363LF0000X	Family Nurse Practitioner	95025586	CA

General Provider Information

NPI Number	:	1417631003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILTONIA ANTOINETTE WARNER

Provider Business Mailing Address
First Line	:	1444 260TH ST UNIT 27
Second Line	:
City	:	HARBOR CITY
State	:	CA
Zip	:	90710-3923
Country	:	US
Telephone Number	:	703-498-7908
Fax Number	:

Provider Business Practice Location Address
First Line	:	1444 260TH ST UNIT 27
Second Line	:
City	:	HARBOR CITY
State	:	CA
Zip	:	90710-3923
Country	:	US
Telephone Number	:	703-498-7908
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/14/2023

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Directions to “ MILTONIA ANTOINETTE WARNER ” Practice Location

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