Provider Demographics
NPI:1427566546
Name:WARREN, NICOLE ELAINE
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:ELAINE
Last Name:WARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:ELAINE
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8432 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3206
Mailing Address - Country:US
Mailing Address - Phone:951-689-5771
Mailing Address - Fax:
Practice Address - Street 1:8432 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-3206
Practice Address - Country:US
Practice Address - Phone:877-228-3615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer