Provider Demographics
NPI:1063465532
Name:WARNDAHL, DEBRA ANN (MSN, NNP-BC, ARNP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:WARNDAHL
Suffix:
Gender:F
Credentials:MSN, NNP-BC, ARNP
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ANN
Other - Last Name:HARWOOD-WARNDAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, NNP, ARNP
Mailing Address - Street 1:205 SHEPHERDS BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-7184
Mailing Address - Country:US
Mailing Address - Phone:813-417-1708
Mailing Address - Fax:
Practice Address - Street 1:3333 SILAS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3013
Practice Address - Country:US
Practice Address - Phone:336-718-3278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014375363LN0000X
FLARNP2004582363LN0000X, 363LN0005X
NC5018082363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308355100Medicaid
FLY0ES0OtherBLUE CROSS BLUE SHIELD
HIVAD000Medicare UPIN