=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578281556
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA JEAN WARREN-CASHMAN APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2022
-----------------------------------------------------
Last Update Date | 08/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4500 COLLEGE AVE
-----------------------------------------------------
City | ALTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62002-5012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-474-3800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11610 E HUTCHISON RD
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62864-7851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-214-5723
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 209-025102
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------