Provider Demographics
NPI:1316296767
Name:WARREN, MICHELLE NICOLE (LPN)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:NICOLE
Last Name:WARREN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:NICOLE
Other - Last Name:MAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2134 SAW MILL RIVER RD
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-4110
Mailing Address - Country:US
Mailing Address - Phone:914-302-2279
Mailing Address - Fax:
Practice Address - Street 1:2134 SAW MILL RIVER RD
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4110
Practice Address - Country:US
Practice Address - Phone:914-302-2279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311186164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse