Provider Demographics
NPI:1861800690
Name:WARREN, NEKKOLI SHEMELL
Entity type:Individual
Prefix:
First Name:NEKKOLI
Middle Name:SHEMELL
Last Name:WARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 PURCELL AVE
Mailing Address - Street 2:#3
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45205-1914
Mailing Address - Country:US
Mailing Address - Phone:513-709-6276
Mailing Address - Fax:
Practice Address - Street 1:1032 PURCELL AVE
Practice Address - Street 2:#3
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45205-1914
Practice Address - Country:US
Practice Address - Phone:513-709-6276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0050794Medicaid