Provider Demographics
NPI:1417547423
Name:WARREN, CHAD JOSEPH (FNP)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:JOSEPH
Last Name:WARREN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:WOOLWICH TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1831
Mailing Address - Country:US
Mailing Address - Phone:856-430-7066
Mailing Address - Fax:
Practice Address - Street 1:105 WINDING WAY
Practice Address - Street 2:
Practice Address - City:WOOLWICH TWP
Practice Address - State:NJ
Practice Address - Zip Code:08085-1831
Practice Address - Country:US
Practice Address - Phone:856-430-7066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-23
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01097000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner