Healthcare Provider Details

I. General information

NPI: 1588204994
Provider Name (Legal Business Name): STEVEN HODNETT WARREN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 GREEN VALLEY RD
GREENSBORO NC
27408-7019
US

IV. Provider business mailing address

21A OAK BRANCH DR
GREENSBORO NC
27407-2145
US

V. Phone/Fax

Practice location:
  • Phone: 336-272-0012
  • Fax:
Mailing address:
  • Phone: 336-478-2664
  • Fax: 336-851-0374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number894569
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: