Provider Demographics
NPI:1083941371
Name:WARBURTON, KERRY ELLEN (RN)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:ELLEN
Last Name:WARBURTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W CRESTVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1370
Mailing Address - Country:US
Mailing Address - Phone:814-466-2867
Mailing Address - Fax:814-466-2867
Practice Address - Street 1:350 W CRESTVIEW AVE
Practice Address - Street 2:
Practice Address - City:BOALSBURG
Practice Address - State:PA
Practice Address - Zip Code:16827-1370
Practice Address - Country:US
Practice Address - Phone:814-466-2867
Practice Address - Fax:814-466-2867
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-08
Last Update Date:2009-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN594297163W00000X, 163WC0400X, 163WG0600X, 163WH0200X, 163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice