MEDICARE: MS. MARY-JANE WARREN PMHNP

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	513149	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	513149	TX

General Provider Information

NPI Number	:	1669658605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY-JANE WARREN PMHNP

Provider Business Mailing Address
First Line	:	1600 W 38TH ST STE 318
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-6406
Country	:	US
Telephone Number	:	512-203-3588
Fax Number	:	512-957-0156

Provider Business Practice Location Address
First Line	:	3625 MANCHACA RD
Second Line	:	#303
City	:	AUSTIN
State	:	TX
Zip	:	78704-6631
Country	:	US
Telephone Number	:	512-328-7222
Fax Number	:	512-328-8222

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

Provider Enumeration Date	:	01/19/2008
Last Update Date	:	06/03/2019

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