Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 3006927 | KY |
NPI | 1013200534 |
---|---|
Provider Name | Bonnie Warner |
First Address | Louisville, KY 40215-1188 |
Second Address | Louisville, KY 40215-1188 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2011 |
Last Update Date | 07/03/2014 |