Provider Demographics
NPI:1740959774
Name:WARNE, JANICE
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:WARNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1404
Mailing Address - Street 2:
Mailing Address - City:NICE
Mailing Address - State:CA
Mailing Address - Zip Code:95464-1404
Mailing Address - Country:US
Mailing Address - Phone:530-713-8512
Mailing Address - Fax:
Practice Address - Street 1:3805 DEXTER LN
Practice Address - Street 2:
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95422-8850
Practice Address - Country:US
Practice Address - Phone:707-996-7738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7222225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist