Basic Information
| Provider Information | |||||||||
| NPI: | 1306964721 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WORDEN | ||||||||
| FirstName: | CATHERINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7742 N. M-149 | ||||||||
| Address2: | PO BOX 506 | ||||||||
| City: | PICKFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9066472217 | ||||||||
| FaxNumber: | 9066472228 | ||||||||
| Practice Location | |||||||||
| Address1: | 7742 N M 129 | ||||||||
| Address2: | |||||||||
| City: | PICKFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497749003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009686866 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 08/09/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 4704179081 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 4704179081 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 5008767040 | 01 | BLUE CROSS BLUE SHIELD | OTHER |