Provider Demographics
NPI:1619908993
Name:WARNER, KAREN JEAN (PA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:JEAN
Last Name:WARNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 S BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:HALLOCK
Mailing Address - State:MN
Mailing Address - Zip Code:56728-4215
Mailing Address - Country:US
Mailing Address - Phone:218-843-2165
Mailing Address - Fax:
Practice Address - Street 1:1010 S BIRCH AVE
Practice Address - Street 2:
Practice Address - City:HALLOCK
Practice Address - State:MN
Practice Address - Zip Code:56728-4215
Practice Address - Country:US
Practice Address - Phone:218-843-2165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9416363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1619908993Medicare PIN
610020100Medicare ID - Type Unspecified
P03548Medicare UPIN