Provider Demographics
NPI:1740308402
Name:WARNER, REBECCA SUZANNE (LAC)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:SUZANNE
Last Name:WARNER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2600 LAKE AUSTIN BLVD
Mailing Address - Street 2:11-305
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4440
Mailing Address - Country:US
Mailing Address - Phone:512-584-0304
Mailing Address - Fax:
Practice Address - Street 1:2700 PECAN ST W
Practice Address - Street 2:STE 780
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3199
Practice Address - Country:US
Practice Address - Phone:512-251-9686
Practice Address - Fax:512-251-9488
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTEMPORARY171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist