Provider Demographics
NPI:1912555988
Name:WARREN, CARLA ANN (APRN)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:ANN
Last Name:WARREN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16308
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-0308
Mailing Address - Country:US
Mailing Address - Phone:503-255-2343
Mailing Address - Fax:503-255-2344
Practice Address - Street 1:883 NW GRANT AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4539
Practice Address - Country:US
Practice Address - Phone:541-320-9555
Practice Address - Fax:541-316-7329
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2024-11-27
Deactivation Date:2024-10-31
Deactivation Code:
Reactivation Date:2024-11-11
Provider Licenses
StateLicense IDTaxonomies
OR10032272363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health