Provider Demographics
NPI:1265734404
Name:WARREN, NANCY D (AUD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:D
Last Name:WARREN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 MENDOCINO AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2261
Mailing Address - Country:US
Mailing Address - Phone:707-566-5201
Mailing Address - Fax:
Practice Address - Street 1:3333 MENDOCINO AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2261
Practice Address - Country:US
Practice Address - Phone:707-566-5201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU3129231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter