MEDICARE: MS. KRISTA ANN WARREN N.P.

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	363LP0200X	Pediatric Nurse Practitioner	16034	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16034	OTHER	CA	NURSE PRACTITIONER

General Provider Information

NPI Number	:	1891906475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTA ANN WARREN N.P.

Provider Business Mailing Address
First Line	:	6672 ALAMITOS CIR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-1537
Country	:	US
Telephone Number	:	714-842-6708
Fax Number	:	714-843-6833

Provider Business Practice Location Address
First Line	:	6672 ALAMITOS CIR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-1537
Country	:	US
Telephone Number	:	714-842-6708
Fax Number	:	714-843-6833

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	05/12/2008

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