Provider Demographics
NPI:1902608375
Name:WARNER, MARCIE LOUISE (APRN)
Entity type:Individual
Prefix:MRS
First Name:MARCIE
Middle Name:LOUISE
Last Name:WARNER
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 BOUNTIFUL LN
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-2878
Mailing Address - Country:US
Mailing Address - Phone:618-339-0109
Mailing Address - Fax:
Practice Address - Street 1:1529 BOUNTIFUL LN
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-2878
Practice Address - Country:US
Practice Address - Phone:618-339-0109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209031624363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health