Healthcare Provider Details

I. General information

NPI: 1437422243
Provider Name (Legal Business Name): KARA ELIZABETH WARREN ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 GOVERNORS PLACE BLVD
DAYTON OH
45409-1328
US

IV. Provider business mailing address

6680 POE AVE STE 200
DAYTON OH
45414-2855
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-1622
  • Fax: 937-245-6308
Mailing address:
  • Phone: 937-280-8366
  • Fax: 937-245-6330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberCOA.13128-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: