Basic Information
| Provider Information | |||||||||
| NPI: | 1134177769 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARNECKE | ||||||||
| FirstName: | BETH | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 MEDICAL DR STE A | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458044030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192226622 | ||||||||
| FaxNumber: | 4192240015 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 MEDICAL DR STE A | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458044030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192226622 | ||||||||
| FaxNumber: | 4192240015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 09/11/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 50.002324 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.