Provider Demographics
NPI:1023523891
Name:WARNER, HEATHER ANGELA (FNP-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANGELA
Last Name:WARNER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E HOLLAND LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:MI
Mailing Address - Zip Code:48884-8317
Mailing Address - Country:US
Mailing Address - Phone:517-712-6617
Mailing Address - Fax:
Practice Address - Street 1:2939 S SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:MI
Practice Address - Zip Code:48888-9285
Practice Address - Country:US
Practice Address - Phone:989-831-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-02
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22849363L00000X
MI4704257143363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner