Healthcare Provider Details

I. General information

NPI: 1245252501
Provider Name (Legal Business Name): JULIE ANN WARREN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 S NATIONAL AVE STE 405
SPRINGFIELD MO
65804-2219
US

IV. Provider business mailing address

1911 S NATIONAL AVE STE 405
SPRINGFIELD MO
65804-2219
US

V. Phone/Fax

Practice location:
  • Phone: 417-881-6533
  • Fax: 417-881-5573
Mailing address:
  • Phone: 417-881-6533
  • Fax: 417-881-5573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2002010074
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: