Provider Demographics
NPI:1356667703
Name:WARNER, SANDY LEE (CFM)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:LEE
Last Name:WARNER
Suffix:
Gender:F
Credentials:CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 W KENNEWICK AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-3128
Mailing Address - Country:US
Mailing Address - Phone:509-628-4819
Mailing Address - Fax:
Practice Address - Street 1:2417 W KENNEWICK AVE
Practice Address - Street 2:SUITE A
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3128
Practice Address - Country:US
Practice Address - Phone:509-628-4819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2009158Medicaid
WA2009158Medicaid