| Doctor Name: | MRS. TONYA RENEE' WARREN |
| NPI Number: | 1942641212 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ANP-BC |
| License Number: | 2013015964 |
| Business Practice Address: | 200 Medical Plz Suite 101 Lake Saint Louis, MO - 633671379 |
| Business Phone Number: | 6365614100 |
| Business Fax Number: | 6365618445 |
| Mailing Address: | Po Box 23340, SAINT LOUIS |
| State: | MO |
| Postal Code: | 631563340 |
| Phone Number: | 6365614100 |
| Fax Number: | 6365618445 |
| NPI Enumeration Date: | 07/15/2013 |
| NPI Last Update Date: | 05/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 2013015964 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |