MEDICARE: TATJANA WARREN CRNA

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	367500000X	Certified Registered Nurse Anesthetist	209.006276 041.35336	IL

General Provider Information

NPI Number	:	1225105828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATJANA WARREN CRNA

Provider Business Mailing Address
First Line	:	864 W 100 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-1107
Country	:	US
Telephone Number	:	858-405-1003
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 N 1900 E RM 3C444
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-2501
Country	:	US
Telephone Number	:	801-581-6393
Fax Number	:	801-581-4367

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	12/16/2021

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