Provider Demographics
NPI:1497513303
Name:WARREN, MARLA RENEE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:RENEE
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 1:2410 PATRICK ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-5207
Mailing Address - Country:US
Mailing Address - Phone:615-852-0997
Mailing Address - Fax:
Practice Address - Street 1:2410 PATRICK ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-5207
Practice Address - Country:US
Practice Address - Phone:615-852-0997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000034039363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology