Provider Demographics
NPI:1225105828
Name:WARREN, TATJANA (CRNA)
Entity Type:Individual
Prefix:
First Name:TATJANA
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:864 W 100 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84104-1107
Mailing Address - Country:US
Mailing Address - Phone:858-405-1003
Mailing Address - Fax:
Practice Address - Street 1:30 N 1900 E RM 3C444
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-2501
Practice Address - Country:US
Practice Address - Phone:801-581-6393
Practice Address - Fax:801-581-4367
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.006276 041.35336367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK39493Medicare PIN