=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003909961
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERRI J WARREN ANP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2330 NW FLANDERS ST SUITE 207
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97210-3442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-226-6678
-----------------------------------------------------
Fax | 503-226-4307
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2330 NW FLANDERS ST SUITE 207
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97210-3442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-226-6678
-----------------------------------------------------
Fax | 503-226-4307
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 082011212N3
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------