Provider Demographics
NPI:1154176162
Name:WARNECKE, MICHAEL (BSN, RN)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:WARNECKE
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75-377 HUALALAI RD
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-9724
Mailing Address - Country:US
Mailing Address - Phone:808-331-4552
Mailing Address - Fax:
Practice Address - Street 1:75-377 HUALALAI RD
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-9724
Practice Address - Country:US
Practice Address - Phone:808-331-4552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201806236RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse