Provider Demographics
NPI:1760973739
Name:WARREN, TAIRA CORYN (FNP-C)
Entity Type:Individual
Prefix:
First Name:TAIRA
Middle Name:CORYN
Last Name:WARREN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 POPLAR DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5207
Mailing Address - Country:US
Mailing Address - Phone:541-414-0481
Mailing Address - Fax:541-789-2558
Practice Address - Street 1:1345 POPLAR DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5207
Practice Address - Country:US
Practice Address - Phone:541-414-0481
Practice Address - Fax:541-789-2558
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201142261163W00000X
OR20186659363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse