Provider Demographics
NPI:1659755098
Name:WARREN, PERIHAN SIMPSON (FNP-C)
Entity Type:Individual
Prefix:
First Name:PERIHAN
Middle Name:SIMPSON
Last Name:WARREN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:PERIHAN
Other - Middle Name:SIMPSON
Other - Last Name:BRANCHE/SHIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:3333 WRIGHTSVILLE AVE STE M
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4115
Mailing Address - Country:US
Mailing Address - Phone:910-399-3519
Mailing Address - Fax:910-769-1739
Practice Address - Street 1:3333 WRIGHTSVILLE AVE STE M
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4115
Practice Address - Country:US
Practice Address - Phone:910-399-3519
Practice Address - Fax:910-769-1739
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC203102163W00000X, 363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health