Provider Demographics
NPI:1295050177
Name:WARNECKE, CODI LYN (RN)
Entity type:Individual
Prefix:MS
First Name:CODI
Middle Name:LYN
Last Name:WARNECKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4504 LAX LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER BAY
Mailing Address - State:MN
Mailing Address - Zip Code:55614-3806
Mailing Address - Country:US
Mailing Address - Phone:218-220-8947
Mailing Address - Fax:
Practice Address - Street 1:4504 LAX LAKE RD
Practice Address - Street 2:
Practice Address - City:SILVER BAY
Practice Address - State:MN
Practice Address - Zip Code:55614-3806
Practice Address - Country:US
Practice Address - Phone:218-220-8947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-02
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR179350-7163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN868K1CAOtherBLUE CROSS BLUE SHEILD