Provider Demographics
NPI:1487399515
Name:WARNER, DERMITRA A
Entity type:Individual
Prefix:MR
First Name:DERMITRA
Middle Name:A
Last Name:WARNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 BAYBERRY DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1007
Mailing Address - Country:US
Mailing Address - Phone:757-270-6083
Mailing Address - Fax:
Practice Address - Street 1:103 BAYBERRY DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1007
Practice Address - Country:US
Practice Address - Phone:757-270-6083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider