Provider Demographics
NPI:1841008471
Name:WARREN, MICHELE DISIREE (FNP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:DISIREE
Last Name:WARREN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9801 BAYLINE CIR
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5621
Mailing Address - Country:US
Mailing Address - Phone:443-600-4025
Mailing Address - Fax:
Practice Address - Street 1:9801 BAYLINE CIR
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5621
Practice Address - Country:US
Practice Address - Phone:443-600-4025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR184908363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily