Provider Demographics
NPI:1225545973
Name:WARNER, ANDREA J (RN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:WARNER
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 1:5651 S WATCHWOOD DR APT 31
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-3830
Mailing Address - Country:US
Mailing Address - Phone:801-623-2198
Mailing Address - Fax:
Practice Address - Street 1:5651 S WATCHWOOD DR APT 31
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-3830
Practice Address - Country:US
Practice Address - Phone:801-623-2198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA195639-3102163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health