Provider Demographics
NPI:1649912247
Name:WARREN, EMMA L
Entity type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:L
Last Name:WARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 SWEETBRIAR AVE
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-2924
Mailing Address - Country:US
Mailing Address - Phone:937-570-8645
Mailing Address - Fax:
Practice Address - Street 1:1506 SWEETBRIAR AVE
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-2924
Practice Address - Country:US
Practice Address - Phone:937-570-8645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2871058Medicaid