Provider Demographics
NPI:1578603254
Name:WARREN, DEBORAH JACKSON (RN,FNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JACKSON
Last Name:WARREN
Suffix:
Gender:F
Credentials:RN,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 SANDY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-8870
Mailing Address - Country:US
Mailing Address - Phone:910-892-2148
Mailing Address - Fax:910-893-9429
Practice Address - Street 1:307 W CORNELIUS HARNETT BLVD
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-9335
Practice Address - Country:US
Practice Address - Phone:910-814-6280
Practice Address - Fax:910-893-9429
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200304363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC3404343Medicaid
NCNC3404456Medicaid
NC183296OtherMEDCOST
NC07212OtherBCBSNC
NCNC3404456Medicaid