Provider Demographics
NPI:1053748657
Name:WARREN, DIANA JUNE
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:JUNE
Last Name:WARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:LEFLORE
Mailing Address - State:OK
Mailing Address - Zip Code:74942-0052
Mailing Address - Country:US
Mailing Address - Phone:918-753-2362
Mailing Address - Fax:918-653-2525
Practice Address - Street 1:43041 S BOOTH
Practice Address - Street 2:
Practice Address - City:LEFLORE
Practice Address - State:OK
Practice Address - Zip Code:74942-0052
Practice Address - Country:US
Practice Address - Phone:918-753-2362
Practice Address - Fax:918-653-2525
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator