Provider Demographics
NPI:1760567275
Name:WARNER, JACQUELINE CHRISTINE (PA-C)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:CHRISTINE
Last Name:WARNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 SHROPSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-2240
Mailing Address - Country:US
Mailing Address - Phone:484-947-5586
Mailing Address - Fax:
Practice Address - Street 1:55 E CUTHBERT BLVD
Practice Address - Street 2:
Practice Address - City:HADDON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08108-2021
Practice Address - Country:US
Practice Address - Phone:856-833-1164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052702363AM0700X
NJ25MP00248900363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical