Provider Demographics
NPI:1801062039
Name:WARREN, SHIRLEY (CRT)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5925 MAPLE AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6515
Mailing Address - Country:US
Mailing Address - Phone:214-353-9090
Mailing Address - Fax:214-353-9594
Practice Address - Street 1:5925 MAPLE AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6515
Practice Address - Country:US
Practice Address - Phone:214-353-9090
Practice Address - Fax:214-353-9594
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX547422278H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1754376-01OtherMEDICAID TPI
TX5120090004Medicare PIN