Provider Demographics
NPI:1629025382
Name:WARR, CONNIE LOUISE (FNP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:LOUISE
Last Name:WARR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:LOUISE
Other - Last Name:KAHALEKOMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:HC 13 BOX 4240
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:UT
Mailing Address - Zip Code:84629-9625
Mailing Address - Country:US
Mailing Address - Phone:435-427-3606
Mailing Address - Fax:
Practice Address - Street 1:740 W 800 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-6300
Practice Address - Country:US
Practice Address - Phone:801-235-0953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT500526-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT500526-4405OtherAPRN