Provider Demographics
NPI:1285024877
Name:WARNER, WALTER III
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:
Last Name:WARNER
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1081 AURORA DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-5508
Mailing Address - Country:US
Mailing Address - Phone:907-457-7759
Mailing Address - Fax:907-457-7481
Practice Address - Street 1:1081 AURORA DR
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5508
Practice Address - Country:US
Practice Address - Phone:907-457-7759
Practice Address - Fax:907-457-7481
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK293586172V00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No172V00000XOther Service ProvidersCommunity Health Worker