Provider Demographics
NPI:1427558691
Name:WARNER, JESSE A (LAC, MSOM)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:A
Last Name:WARNER
Suffix:
Gender:M
Credentials:LAC, MSOM
Other - Prefix:
Other - First Name:JESSE
Other - Middle Name:A
Other - Last Name:BEIERMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC, MSOM
Mailing Address - Street 1:107 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-1157
Mailing Address - Country:US
Mailing Address - Phone:262-475-3535
Mailing Address - Fax:
Practice Address - Street 1:107 N 3RD ST
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115-1157
Practice Address - Country:US
Practice Address - Phone:262-475-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001415171100000X
WI985-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL198.001415OtherSTATE
WI985-55OtherSTATE