Provider Demographics
NPI:1376692087
Name:WARREN, KAREN M (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:M
Last Name:WARREN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S RAISINVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-9754
Mailing Address - Country:US
Mailing Address - Phone:734-384-8595
Mailing Address - Fax:734-243-5506
Practice Address - Street 1:1001 S RAISINVILLE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-9754
Practice Address - Country:US
Practice Address - Phone:734-384-8595
Practice Address - Fax:734-243-5506
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704176195363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4835071Medicaid
MIN92900002Medicare ID - Type UnspecifiedBILLING ID FOR MEDICARE