Individual
TYLER SCOTT WARREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(774) 443-7552
(774) 441-6086
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN2276898
MA
363LC0200X
Critical Care Medicine Nurse Practitioner
RN2276898
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110119650A
—
MA
Enumeration date
10/31/2016
Last updated
11/16/2020
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