1841215084 NPI number — SANDRIA RENEE WARREN CRNP

Table of content: SANDRIA RENEE WARREN CRNP (NPI 1841215084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841215084 NPI number — SANDRIA RENEE WARREN CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARREN
Provider First Name:
SANDRIA
Provider Middle Name:
RENEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BALDWIN
Provider Other First Name:
SANDRIA
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841215084
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4145 CARMICHAEL ROAD
Provider Second Line Business Mailing Address:
MONTGOMERY CANCER CENTER
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36106-2803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-273-7000
Provider Business Mailing Address Fax Number:
334-273-2386

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4145 CARMICHAEL ROAD
Provider Second Line Business Practice Location Address:
MONTGOMERY CANCER CENTER
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36106-2803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-273-7000
Provider Business Practice Location Address Fax Number:
334-273-2228
Provider Enumeration Date:
07/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X , with the licence number:  1-095567 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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