1710234489 NPI number — MS. JACQUELYN RENEE WARNER FNP-BC, IFMCP

Table of content: MS. JACQUELYN RENEE WARNER FNP-BC, IFMCP (NPI 1710234489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710234489 NPI number — MS. JACQUELYN RENEE WARNER FNP-BC, IFMCP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARNER
Provider First Name:
JACQUELYN
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC, IFMCP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FAUNCE
Provider Other First Name:
JACQUELYN
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
DNP, FNP-BC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1710234489
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
134 N YORK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELMHURST
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60126-2806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-477-7373
Provider Business Mailing Address Fax Number:
312-268-6550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
134 N YORK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELMHURST
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60126-2806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-477-7373
Provider Business Practice Location Address Fax Number:
312-268-6550
Provider Enumeration Date:
08/13/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  17024 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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