Provider Demographics
NPI:1295868180
Name:WOSTAL, CAROL JEAN (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:JEAN
Last Name:WOSTAL
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 N ALPHA ST
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-5000
Mailing Address - Country:US
Mailing Address - Phone:928-753-4394
Mailing Address - Fax:928-769-2971
Practice Address - Street 1:943 HUALAPAI WAY
Practice Address - Street 2:
Practice Address - City:PEACH SPRINGS
Practice Address - State:AZ
Practice Address - Zip Code:86434
Practice Address - Country:US
Practice Address - Phone:928-769-2900
Practice Address - Fax:928-769-2971
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN017386163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1598795825Medicare ID - Type Unspecified
AZ1942318654Medicare ID - Type Unspecified