Provider Demographics
NPI:1073517884
Name:WARNER, SUZY P (RN-C, PNP)
Entity Type:Individual
Prefix:MS
First Name:SUZY
Middle Name:P
Last Name:WARNER
Suffix:
Gender:F
Credentials:RN-C, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5282 MEDICAL DR
Mailing Address - Street 2:STE 310
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6044
Mailing Address - Country:US
Mailing Address - Phone:210-614-8687
Mailing Address - Fax:210-614-7529
Practice Address - Street 1:5282 MEDICAL DR
Practice Address - Street 2:STE 310
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6044
Practice Address - Country:US
Practice Address - Phone:210-614-8687
Practice Address - Fax:210-614-7529
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX243198363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81N951Medicare ID - Type Unspecified