Healthcare Provider Details

I. General information

NPI: 1396768396
Provider Name (Legal Business Name): FAYE F. WARREN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 BEAMAN ST
CLINTON NC
28328-2602
US

IV. Provider business mailing address

1004 BEAMAN ST
CLINTON NC
28328-2329
US

V. Phone/Fax

Practice location:
  • Phone: 910-592-9113
  • Fax: 910-590-0050
Mailing address:
  • Phone: 910-592-9113
  • Fax: 910-590-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201487
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: