Provider Demographics
NPI:1073320008
Name:WARBERTON, DE-ANDRA DANEISHA (NP)
Entity type:Individual
Prefix:
First Name:DE-ANDRA
Middle Name:DANEISHA
Last Name:WARBERTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 ROUTE 70
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1569
Mailing Address - Country:US
Mailing Address - Phone:212-516-2300
Mailing Address - Fax:
Practice Address - Street 1:277 ROUTE 70
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-1569
Practice Address - Country:US
Practice Address - Phone:212-516-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311882363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health