Healthcare Provider Details

I. General information

NPI: 1407668817
Provider Name (Legal Business Name): MRS. MEGAN RENEE WARREN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MEGAN RENEE KEMPLE

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 E BLOOMINGTON FWY
BLOOMINGTON MN
55420-1036
US

IV. Provider business mailing address

4604 LOFTWOOD RD
MADERA CA
93636-8033
US

V. Phone/Fax

Practice location:
  • Phone: 800-854-2772
  • Fax:
Mailing address:
  • Phone: 559-473-5783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAD8651
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: