Healthcare Provider Details

I. General information

NPI: 1982880266
Provider Name (Legal Business Name): TINA IRENE WARREN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3628 HOMEWOOD AVE
TOLEDO OH
43612-1008
US

IV. Provider business mailing address

3628 HOMEWOOD AVE
TOLEDO OH
43612-1008
US

V. Phone/Fax

Practice location:
  • Phone: 419-708-0598
  • Fax:
Mailing address:
  • Phone: 419-708-0598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN-273314
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: