Provider Demographics
NPI:1881194397
Name:WARREN, JOHNNIE LEE JR (LVN)
Entity Type:Individual
Prefix:MR
First Name:JOHNNIE
Middle Name:LEE
Last Name:WARREN
Suffix:JR
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:148 RIFLE GAP
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3628
Mailing Address - Country:US
Mailing Address - Phone:210-602-5378
Mailing Address - Fax:210-945-0273
Practice Address - Street 1:7330 SAN PEDRO AVE STE 800
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6268
Practice Address - Country:US
Practice Address - Phone:210-733-0524
Practice Address - Fax:866-760-4570
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX129093164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse