Provider Demographics
NPI:1104636539
Name:WARREN, CHANCIE (PMHNP)
Entity type:Individual
Prefix:
First Name:CHANCIE
Middle Name:
Last Name:WARREN
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:CHANCIE
Other - Middle Name:
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 W TEMPLE AVE STE 1500
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2121
Mailing Address - Country:US
Mailing Address - Phone:217-347-0458
Mailing Address - Fax:
Practice Address - Street 1:900 W TEMPLE AVE STE 1500
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2121
Practice Address - Country:US
Practice Address - Phone:217-347-0458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209031536363L00000X
IL041417657163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse