Healthcare Provider Details

I. General information

NPI: 1316861560
Provider Name (Legal Business Name): DAMITA WARREN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17828 CLOVER ST
BROWNSTOWN MI
48193-8806
US

IV. Provider business mailing address

17828 CLOVER ST
BROWNSTOWN MI
48193-8806
US

V. Phone/Fax

Practice location:
  • Phone: 313-332-8575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704242149
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: