Healthcare Provider Details

I. General information

NPI: 1386100360
Provider Name (Legal Business Name): PERIHAN S. WARREN, FNP-C , LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 WRIGHTSVILLE AVE STE M
WILMINGTON NC
28403-4115
US

IV. Provider business mailing address

3333 WRIGHTSVILLE AVE STE M
WILMINGTON NC
28403-4115
US

V. Phone/Fax

Practice location:
  • Phone: 910-339-3519
  • Fax: 910-769-1739
Mailing address:
  • Phone: 910-339-3519
  • Fax: 910-769-1739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL HEATH
Title or Position: OFFICE MANAGER
Credential: OFFICE MANAGER
Phone: 910-399-3519