Healthcare Provider Details

I. General information

NPI: 1528856986
Provider Name (Legal Business Name): OLIN LEE WARREN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHIMNEY POINT DR
OGDENSBURG NY
13669-2291
US

IV. Provider business mailing address

1009 FRANKLIN ST
WATERTOWN NY
13601-3833
US

V. Phone/Fax

Practice location:
  • Phone: 315-541-2001
  • Fax:
Mailing address:
  • Phone: 315-489-5112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number872142
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number872142
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: