Provider Demographics
NPI:1942641212
Name:WARREN, TONYA RENEE' (ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:RENEE'
Last Name:WARREN
Suffix:
Gender:F
Credentials:ANP-BC
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 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:636-561-4100
Mailing Address - Fax:636-561-8445
Practice Address - Street 1:200 MEDICAL PLZ
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1379
Practice Address - Country:US
Practice Address - Phone:636-561-4100
Practice Address - Fax:636-561-8445
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013015964363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health