Provider Demographics
NPI:1316821507
Name:WARNER, SAMUAL JOHN
Entity type:Individual
Prefix:
First Name:SAMUAL
Middle Name:JOHN
Last Name:WARNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3954 RIG RD
Mailing Address - Street 2:
Mailing Address - City:MOOREFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26836-8207
Mailing Address - Country:US
Mailing Address - Phone:304-703-0124
Mailing Address - Fax:
Practice Address - Street 1:3954 RIG RD
Practice Address - Street 2:
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836-8207
Practice Address - Country:US
Practice Address - Phone:304-703-0124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant