Provider Demographics
NPI:1407378482
Name:WARREN, ADAM NICHOLAS
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:NICHOLAS
Last Name:WARREN
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 1:5564 CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-1665
Mailing Address - Country:US
Mailing Address - Phone:419-344-9091
Mailing Address - Fax:419-720-8935
Practice Address - Street 1:5029 TRACTOR RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-3435
Practice Address - Country:US
Practice Address - Phone:419-344-9091
Practice Address - Fax:419-720-8935
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)