MEDICARE: OKEYSEKHAN L WARREN

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	363LP0200X	Pediatric Nurse Practitioner	21453	CA

General Provider Information

NPI Number	:	1689991457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OKEYSEKHAN L WARREN

Provider Business Mailing Address
First Line	:	2500 E PINE ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-3044
Country	:	US
Telephone Number	:	206-334-7435
Fax Number	:

Provider Business Practice Location Address
First Line	:	2732 MABEL ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-2345
Country	:	US
Telephone Number	:	206-334-7435
Fax Number	:

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

Provider Enumeration Date	:	05/03/2010
Last Update Date	:	08/31/2025

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