Healthcare Provider Details

I. General information

NPI: 1043127327
Provider Name (Legal Business Name): MADALAINE WARREN BSN, RN, CLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 SUPERIOR ST
SANDUSKY OH
44870-1849
US

IV. Provider business mailing address

2 KATHERINE WAY
NORWALK OH
44857-8758
US

V. Phone/Fax

Practice location:
  • Phone: 419-626-5623
  • Fax:
Mailing address:
  • Phone: 740-504-1583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number492983
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: