MEDICARE: WARRINER, LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	119357	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1124168265	OTHER	CO	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1821355025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WARRINER, LLC

Provider Business Mailing Address
First Line	:	1301 S 8TH ST
Second Line	:	SUITE 109
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-7335
Country	:	US
Telephone Number	:	719-440-0126
Fax Number	:	719-632-4078

Provider Business Practice Location Address
First Line	:	1301 S 8TH ST
Second Line	:	SUITE 109
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-7335
Country	:	US
Telephone Number	:	719-440-0126
Fax Number	:	719-632-4078

Authorized Official
Title or Position	:	CEO
Name	:	CYNTHIA LEE WARRINER
Credential	:	FPNP-BC
Telephone Number	:	719-440-0126

Provider Enumeration Date	:	04/12/2012
Last Update Date	:	04/12/2012

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