Provider Demographics
NPI:1194599753
Name:WARNER, SANDRA ELAINE
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ELAINE
Last Name:WARNER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 GREEN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-8113
Mailing Address - Country:US
Mailing Address - Phone:517-915-8157
Mailing Address - Fax:
Practice Address - Street 1:103 N CLINTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-1501
Practice Address - Country:US
Practice Address - Phone:517-915-8157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501015769225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist