Provider Demographics
NPI:1700834694
Name:WARNER, CHRISTINE CORRAL
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:CORRAL
Last Name:WARNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5182 B CRACKER JACK LN
Mailing Address - Street 2:
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310-2073
Mailing Address - Country:US
Mailing Address - Phone:760-386-4458
Mailing Address - Fax:
Practice Address - Street 1:5182 BCRACKER JACK LN
Practice Address - Street 2:
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310-2073
Practice Address - Country:US
Practice Address - Phone:760-386-4458
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556709163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse