1396123964 NPI number — LAUREN MEREDITH WARNER MD

Table of content: LAUREN MEREDITH WARNER MD (NPI 1396123964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396123964 NPI number — LAUREN MEREDITH WARNER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARNER
Provider First Name:
LAUREN
Provider Middle Name:
MEREDITH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COOK
Provider Other First Name:
LAUREN
Provider Other Middle Name:
MEREDITH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396123964
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5900 BYRON CENTER AVE SW
Provider Second Line Business Mailing Address:
MEDICAL ADMINISTRATION
Provider Business Mailing Address City Name:
WYOMING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49519-9606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
162-523-9006
Provider Business Mailing Address Fax Number:
616-252-3920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11160 W J PRESLEY PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ALLENDALE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-252-3900
Provider Business Practice Location Address Fax Number:
616-252-3920
Provider Enumeration Date:
05/14/2015

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: 207Q00000X , with the licence number:  MT208965 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1396123964 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com