Healthcare Provider Details

I. General information

NPI: 1700138328
Provider Name (Legal Business Name): LORENA WARREN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 08/13/2023
Certification Date: 08/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N CORONADO DR
SIERRA VISTA AZ
85635-6358
US

IV. Provider business mailing address

3032 CARDINAL DR
SIERRA VISTA AZ
85635-4227
US

V. Phone/Fax

Practice location:
  • Phone: 520-459-1529
  • Fax:
Mailing address:
  • Phone: 520-508-2331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTAP4667
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: