Provider Demographics
NPI:1790345353
Name:WARRICK, EDEN SONJA (PA-C)
Entity Type:Individual
Prefix:
First Name:EDEN
Middle Name:SONJA
Last Name:WARRICK
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 1:4112 LINKS LN STE 205
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-3903
Mailing Address - Country:US
Mailing Address - Phone:512-451-0139
Mailing Address - Fax:
Practice Address - Street 1:4112 LINKS LN STE 205
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-3903
Practice Address - Country:US
Practice Address - Phone:512-451-0139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant