Provider Demographics
NPI:1710969084
Name:WARNICK, GRANT (CRNA)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:
Last Name:WARNICK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 MCCUE RD
Mailing Address - Street 2:SUITE 1604
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-7100
Mailing Address - Country:US
Mailing Address - Phone:903-922-1694
Mailing Address - Fax:
Practice Address - Street 1:3030 S GESSNER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-3765
Practice Address - Country:US
Practice Address - Phone:903-922-1694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94480367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1674269-01Medicaid
S06411Medicare UPIN
TX1674269-01Medicaid
8B6698Medicare PIN