Provider Demographics
NPI:1013749290
Name:WARNECKE, DILLON TYLER
Entity type:Individual
Prefix:
First Name:DILLON
Middle Name:TYLER
Last Name:WARNECKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1737 W PORTSMITH LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-7452
Mailing Address - Country:US
Mailing Address - Phone:630-267-6803
Mailing Address - Fax:
Practice Address - Street 1:1737 W PORTSMITH LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-7452
Practice Address - Country:US
Practice Address - Phone:630-267-6803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.482251163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse