Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | ME 63433 | FL |
NPI | 1265542229 |
---|---|
Provider Name | Dr. Jeannette G Warner |
First Address | Palm Bay, FL 32907-2556 |
Second Address | Palm Bay, FL 32907-2556 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 26/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
59-3444276 | TAX IDENTIFICATION (01) | FL |
C33346 | (02) | FL |