Individual
AUDRIC RANEL WARREN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, ATC, PES, CES
Contact information
Practice address
3672 TYLER ST, GARY, IN 46408-1638
(219) 794-4653
Mailing address
3672 TYLER ST, GARY, IN 46408-1638
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
096002610
IL
2255A2300X
Athletic Trainer
Primary
36001470A
IN
Other
Enumeration date
02/04/2013
Last updated
02/04/2013
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