MEDICARE: MS. CAROL ANN WOOTEN LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN 106543	OH

General Provider Information

NPI Number	:	1538107958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL ANN WOOTEN LPN

Provider Business Mailing Address
First Line	:	5983 AMANDA NORTHERN RD
Second Line	:
City	:	CARROLL
State	:	OH
Zip	:	43112-9619
Country	:	US
Telephone Number	:	614-833-3397
Fax Number	:	614-833-3307

Provider Business Practice Location Address
First Line	:	5983 AMANDA NORTHERN RD
Second Line	:
City	:	CARROLL
State	:	OH
Zip	:	43112-9619
Country	:	US
Telephone Number	:	614-830-7428
Fax Number	:	614-307-4280

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	07/08/2007

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