Provider Demographics
NPI:1891139754
Name:WARNER, STACEY ANN (CPNP)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:ANN
Last Name:WARNER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4755 E CESAR E CHAVEZ AVE
Mailing Address - Street 2:STE. A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-1267
Mailing Address - Country:US
Mailing Address - Phone:323-262-4194
Mailing Address - Fax:
Practice Address - Street 1:4755 E CESAR E CHAVEZ AVE
Practice Address - Street 2:STE. A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1267
Practice Address - Country:US
Practice Address - Phone:323-262-4194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2016-09-29
Deactivation Date:2015-02-05
Deactivation Code:
Reactivation Date:2016-09-12
Provider Licenses
StateLicense IDTaxonomies
CA19366363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics