Individual
NICHOLAS WARNECKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
112 NE CRESCENT AVE, PEORIA, IL 61606-1901
(309) 672-4670
Mailing address
5100 RELIABLE PKWY, CHICAGO, IL 60686-0001
(309) 672-4809
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003358
IL
Other
Enumeration date
10/15/2008
Last updated
10/15/2008
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