Provider Demographics
NPI:1841215084
Name:WARREN, SANDRIA RENEE (CRNP)
Entity Type:Individual
Prefix:
First Name:SANDRIA
Middle Name:RENEE
Last Name:WARREN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:SANDRIA
Other - Middle Name:RENEE
Other - Last Name:BALDWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:4145 CARMICHAEL ROAD
Mailing Address - Street 2:MONTGOMERY CANCER CENTER
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2803
Mailing Address - Country:US
Mailing Address - Phone:334-273-7000
Mailing Address - Fax:334-273-2386
Practice Address - Street 1:4145 CARMICHAEL ROAD
Practice Address - Street 2:MONTGOMERY CANCER CENTER
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2803
Practice Address - Country:US
Practice Address - Phone:334-273-7000
Practice Address - Fax:334-273-2228
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-095567363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051525626BALMedicare ID - Type UnspecifiedPROVIDER NUMBER
Q32042Medicare UPIN