Provider Demographics
NPI:1588275853
Name:WARNER, AMBER DAWN
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:DAWN
Last Name:WARNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 S TIMBERLAND DR STE H
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-0462
Mailing Address - Country:US
Mailing Address - Phone:936-671-9992
Mailing Address - Fax:
Practice Address - Street 1:212 S TIMBERLAND DR STE H
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-0462
Practice Address - Country:US
Practice Address - Phone:936-671-9992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1003222363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily