Provider Demographics
NPI:1457656886
Name:WARNER, ELISABETH R (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:R
Last Name:WARNER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2197 W 13250 S
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-6220
Mailing Address - Country:US
Mailing Address - Phone:508-932-8403
Mailing Address - Fax:
Practice Address - Street 1:2197 W 13250 S
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-6220
Practice Address - Country:US
Practice Address - Phone:508-932-8403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-15
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000955363LP0808X
MTNUR-APRN-LIC-100000363LP0808X
CT5917363LP0808X
TX884003363LP0808X
MECNP131124363LP0808X
NH063101-23363LP0808X
CA95005444363LP0808X
MARN215569363LP0808X
AK1437363LP0808X
AZAP8328363LP0808X
UT9461344-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA27-4557552OtherEIN