Provider Demographics
NPI:1710952791
Name:WARNICK, CAROL A (NP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:WARNICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 MURRAY HOLLADAY RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4901
Mailing Address - Country:US
Mailing Address - Phone:801-268-2584
Mailing Address - Fax:801-262-1168
Practice Address - Street 1:999 MURRAY HOLLADAY RD
Practice Address - Street 2:SUITE 207
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4901
Practice Address - Country:US
Practice Address - Phone:801-268-2584
Practice Address - Fax:801-262-1168
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2197994405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870573947004Medicaid
S78325Medicare UPIN
UT005553106Medicare ID - Type Unspecified