Provider Demographics
NPI:1477569473
Name:WARREN, MARILYN R (RN, CNS, RXS)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:R
Last Name:WARREN
Suffix:
Gender:F
Credentials:RN, CNS, RXS
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:RUTH
Other - Last Name:SEIBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CNS
Mailing Address - Street 1:28374 COUNTY ROAD 317
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81211-9158
Mailing Address - Country:US
Mailing Address - Phone:719-539-6502
Mailing Address - Fax:719-539-3988
Practice Address - Street 1:28374 COUNTY ROAD 317
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211-9158
Practice Address - Country:US
Practice Address - Phone:719-538-6502
Practice Address - Fax:719-539-3988
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN29972364SP0807X, 364SP0809X
COCNS-3854364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult