Basic Information
Provider Information | |||||||||
NPI: | 1225466238 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WARREN | ||||||||
FirstName: | BRITTNEY | ||||||||
MiddleName: | NICHOLE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PA-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | CRIST | ||||||||
OtherFirstName: | BRITTNEY | ||||||||
OtherMiddleName: | NICHOLE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PA-C | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 7792 MISTY SHORE DR | ||||||||
Address2: |   | ||||||||
City: | WEST CHESTER | ||||||||
State: | OH | ||||||||
PostalCode: | 450699645 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9378857163 | ||||||||
FaxNumber: | 5132753262 | ||||||||
Practice Location | |||||||||
Address1: | 7792 MISTY SHORE DR | ||||||||
Address2: |   | ||||||||
City: | WEST CHESTER | ||||||||
State: | OH | ||||||||
PostalCode: | 450699645 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9378857163 | ||||||||
FaxNumber: | 5132753262 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/30/2013 | ||||||||
LastUpdateDate: | 01/25/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 003839 | OH | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   |
No ID Information.