1669700050 NPI number — MARYH. WARREN, ARNP, PLLC

Table of content: (NPI 1669700050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669700050 NPI number — MARYH. WARREN, ARNP, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARYH. WARREN, ARNP, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669700050
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 PINE STREET EXT
Provider Second Line Business Mailing Address:
#6 MILL ANNEX, STE K
Provider Business Mailing Address City Name:
NASHUA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03060-3248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-886-4800
Provider Business Mailing Address Fax Number:
603-886-4810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 PINE STREET EXT
Provider Second Line Business Practice Location Address:
#6 MILL ANNEX, STE K
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03060-3248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-886-4800
Provider Business Practice Location Address Fax Number:
603-886-4810
Provider Enumeration Date:
11/24/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TYRRELL
Authorized Official First Name:
JEANNE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
603-886-4800

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  027571-23-08 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30344944 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".