Provider Demographics
NPI:1801665344
Name:WARNER, JUDY ELLEN
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:ELLEN
Last Name:WARNER
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 1:3123 WENDEL RD
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354-7545
Mailing Address - Country:US
Mailing Address - Phone:304-677-5091
Mailing Address - Fax:
Practice Address - Street 1:3123 WENDEL RD
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354-7545
Practice Address - Country:US
Practice Address - Phone:304-677-5091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant