Provider Demographics
NPI:1790347623
Name:WARNICK, BECCA (FNP)
Entity Type:Individual
Prefix:
First Name:BECCA
Middle Name:
Last Name:WARNICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:RUPERT
Mailing Address - State:ID
Mailing Address - Zip Code:83350-1527
Mailing Address - Country:US
Mailing Address - Phone:208-434-8236
Mailing Address - Fax:208-436-6308
Practice Address - Street 1:1308 8TH ST STE 1
Practice Address - Street 2:
Practice Address - City:RUPERT
Practice Address - State:ID
Practice Address - Zip Code:83350-1535
Practice Address - Country:US
Practice Address - Phone:208-436-4322
Practice Address - Fax:208-436-1312
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID63303363LF0000X
WAAP60997785363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily