Provider Demographics
NPI:1639121205
Name:WARREN, DAVID P (LPN)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:WARREN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 TALL TIMBERS RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-3447
Mailing Address - Country:US
Mailing Address - Phone:937-836-9295
Mailing Address - Fax:
Practice Address - Street 1:105 TALL TIMBERS RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-3447
Practice Address - Country:US
Practice Address - Phone:937-836-9295
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN117459164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse