Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 4704176195 | MI |
NPI | 1376692087 |
---|---|
Provider Name | Ms. Karen M Warren |
First Address | Monroe, MI 48161-9754 |
Second Address | Monroe, MI 48161-9754 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 04/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4835071 | (05) | MI |