Individual
JOHANNA BETH WARREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10330 SE 32ND AVE, SUITE 205, MILWAUKIE, OR 97222-6587
(503) 513-8950
Mailing address
PO BOX 3158, SUITE C, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD25775
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
243038
—
OR
Enumeration date
08/01/2006
Last updated
10/31/2016
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