Provider Demographics
NPI:1700104015
Name:WARREN, SHERISA (DO)
Entity Type:Individual
Prefix:DR
First Name:SHERISA
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:DO
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 258857
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73125-8857
Mailing Address - Country:US
Mailing Address - Phone:405-241-3539
Mailing Address - Fax:405-241-0998
Practice Address - Street 1:3200 QUAIL SPRINGS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-2699
Practice Address - Country:US
Practice Address - Phone:405-701-9880
Practice Address - Fax:405-701-9881
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018187208600000X
KYTP417208600000X, 2086S0129X
OK7204208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK7204OtherSTATE LICENSE