MEDICARE: CATHERINE WORDEN

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	363L00000X	Nurse Practitioner	4704179081	MI
2	363LF0000X	Family Nurse Practitioner	4704179081	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5008767040	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1306964721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE WORDEN

Provider Business Mailing Address
First Line	:	7742 N. M-149
Second Line	:	PO BOX 506
City	:	PICKFORD
State	:	MI
Zip	:	49774
Country	:	US
Telephone Number	:	906-647-2217
Fax Number	:	906-647-2228

Provider Business Practice Location Address
First Line	:	7742 N M 129
Second Line	:
City	:	PICKFORD
State	:	MI
Zip	:	49774-9003
Country	:	US
Telephone Number	:	800-968-6866
Fax Number	:

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	08/09/2013

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Directions to “ CATHERINE WORDEN ” Practice Location

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