Provider Demographics
NPI:1093034258
Name:WARREN, AMBER RENEE (DO)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:RENEE
Last Name:WARREN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 LITTLE MEADOW RUN RD
Mailing Address - Street 2:
Mailing Address - City:MT MORRIS
Mailing Address - State:PA
Mailing Address - Zip Code:15349-2305
Mailing Address - Country:US
Mailing Address - Phone:724-998-6339
Mailing Address - Fax:
Practice Address - Street 1:120 LOCUST AVE EXT
Practice Address - Street 2:
Practice Address - City:MT MORRIS
Practice Address - State:PA
Practice Address - Zip Code:15349-1355
Practice Address - Country:US
Practice Address - Phone:724-324-2982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAOS016428207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program