Basic Information
| Provider Information | |||||||||
| NPI: | 1174559413 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARFIELD | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | RAE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WOODARD | ||||||||
| OtherFirstName: | CAROL | ||||||||
| OtherMiddleName: | RAE | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | APN, FNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1207 NETWORK CENTRE DR | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624014632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173472707 | ||||||||
| FaxNumber: | 2173472827 | ||||||||
| Practice Location | |||||||||
| Address1: | 512 N MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624012005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173477030 | ||||||||
| FaxNumber: | 2173477049 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 05/02/2014 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209-000684 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | MW0715029 | 01 | IL | DEA | OTHER | 041112424 | 01 | IL | RN LICENSE | OTHER | 209000684 | 01 | IL | NURSE PRACTITIONER LICENSE | OTHER | 309000228 | 01 | IL | NURSE PRACTITIONER CONTROLLED SUBS LICENSE | OTHER |