Provider Demographics
NPI:1215911979
Name:WARRINER, WALTER HOWARD (NPP)
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:HOWARD
Last Name:WARRINER
Suffix:
Gender:M
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 MAIN STREET,
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NY
Mailing Address - Zip Code:14772
Mailing Address - Country:US
Mailing Address - Phone:716-358-3636
Mailing Address - Fax:716-358-2342
Practice Address - Street 1:356 MAIN STREET
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NY
Practice Address - Zip Code:14772
Practice Address - Country:US
Practice Address - Phone:716-358-3636
Practice Address - Fax:716-358-2342
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health