Provider Demographics
NPI:1740284587
Name:WARREN, NAOMI R (FNP)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:R
Last Name:WARREN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:MONAHANS
Mailing Address - State:TX
Mailing Address - Zip Code:79756-0040
Mailing Address - Country:US
Mailing Address - Phone:432-943-2511
Mailing Address - Fax:432-943-9415
Practice Address - Street 1:813 E 4TH ST
Practice Address - Street 2:
Practice Address - City:MONAHANS
Practice Address - State:TX
Practice Address - Zip Code:79756-4015
Practice Address - Country:US
Practice Address - Phone:432-943-2068
Practice Address - Fax:432-943-3114
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX437880363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121418103Medicaid
TX121418103Medicaid