MEDICARE: MRS. JUDY LYNN WARREN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	6802065069	MI

General Provider Information

NPI Number	:	1437496965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUDY LYNN WARREN

Provider Business Mailing Address
First Line	:	11465 CULVER RD
Second Line	:
City	:	CEMENT CITY
State	:	MI
Zip	:	49233-9608
Country	:	US
Telephone Number	:	517-529-4331
Fax Number	:

Provider Business Practice Location Address
First Line	:	11465 CULVER RD
Second Line	:
City	:	CEMENT CITY
State	:	MI
Zip	:	49233-9608
Country	:	US
Telephone Number	:	517-529-4331
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2013
Last Update Date	:	01/03/2013

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