Provider Demographics
NPI:1346581733
Name:WARNER, JESSICA A (RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
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 1:21 BONNELL ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-5632
Mailing Address - Country:US
Mailing Address - Phone:518-810-4750
Mailing Address - Fax:
Practice Address - Street 1:21 BONNELL ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-5632
Practice Address - Country:US
Practice Address - Phone:518-810-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY635235163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse