Provider Demographics
NPI:1295803229
Name:WARNER, SUSAN CATHERINE (DPM)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:CATHERINE
Last Name:WARNER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16896 IRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:DRAKESVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52552-8500
Mailing Address - Country:US
Mailing Address - Phone:641-664-3667
Mailing Address - Fax:641-664-3549
Practice Address - Street 1:110 N. DODGE ST.
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:IA
Practice Address - Zip Code:52537-1463
Practice Address - Country:US
Practice Address - Phone:641-664-3667
Practice Address - Fax:641-664-3549
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00699213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1191494Medicaid
IAU71891Medicare UPIN
IA1191494Medicaid