MEDICARE: RICHARD T WARREN ANP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	1134151822	OR
2	363L00000X	Nurse Practitioner	084054476N3	OR

General Provider Information

NPI Number	:	1134151822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD T WARREN ANP

Provider Business Mailing Address
First Line	:	PO BOX 3158
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3158
Country	:	US
Telephone Number	:	503-215-6494
Fax Number	:	503-215-6644

Provider Business Practice Location Address
First Line	:	6350 NE HALSEY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-4720
Country	:	US
Telephone Number	:	503-215-2669
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	02/16/2021

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