Individual
MARISA WARREN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
2495 RAY RD, SPRING LAKE, NC 28390-7531
(910) 436-1436
Mailing address
1006 W LADY DIANA CT, APEX, NC 27502-9260
(919) 616-8690
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
LAT-3011
NC
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000024503
BOARD OF CERTIFICATION CERTIFIED ATHLETIC TRAINER
NC
01
—
LAT-3011
NORTH CAROLINA BOARD OF ATHLETIC TRAINER EXAMINERS
NC
Enumeration date
09/19/2016
Last updated
10/07/2016
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