Healthcare Provider Details

I. General information

NPI: 1174559413
Provider Name (Legal Business Name): MS. CAROL RAE WARFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL RAE WOODARD APN, FNP

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 N MAPLE ST
EFFINGHAM IL
62401-2005
US

IV. Provider business mailing address

1207 NETWORK CENTRE DR SUITE 3
EFFINGHAM IL
62401-4632
US

V. Phone/Fax

Practice location:
  • Phone: 217-347-7030
  • Fax: 217-347-7049
Mailing address:
  • Phone: 217-347-2707
  • Fax: 217-347-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-000684
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: