Provider Demographics
NPI:1053904805
Name:WARCZINSKY, JASON JOHN
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:JOHN
Last Name:WARCZINSKY
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 1:8269 HIDDEN HOLW
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-4403
Mailing Address - Country:US
Mailing Address - Phone:810-931-5839
Mailing Address - Fax:
Practice Address - Street 1:1121 W HILL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-4733
Practice Address - Country:US
Practice Address - Phone:810-232-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704350108163W00000X
MI2021102560363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse