Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 209014375 | IL |
Y | 363LN0000X | Nurse Practitioner - Neonatal | ARNP2004582 | FL |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | ARNP2004582 | FL |
NPI | 1063465532 |
---|---|
Provider Name | Debra Ann Warndahl |
First Address | Bettendorf, IA 52722-1626 |
Second Address | St Petersburg, FL 33701-4804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 16/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
308355100 | (05) | FL |
VAD000 | (02) | HI |
Y0ES0 | BLUE CROSS BLUE SHIELD (01) | FL |