Provider Demographics
NPI:1669700050
Name:MARYH. WARREN, ARNP, PLLC
Entity type:Organization
Organization Name:MARYH. WARREN, ARNP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:TYRRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-886-4800
Mailing Address - Street 1:5 PINE STREET EXT
Mailing Address - Street 2:#6 MILL ANNEX, STE K
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3248
Mailing Address - Country:US
Mailing Address - Phone:603-886-4800
Mailing Address - Fax:603-886-4810
Practice Address - Street 1:5 PINE STREET EXT
Practice Address - Street 2:#6 MILL ANNEX, STE K
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3248
Practice Address - Country:US
Practice Address - Phone:603-886-4800
Practice Address - Fax:603-886-4810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH027571-23-08363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30344944Medicaid