Provider Demographics
NPI:1508811308
Name:WORDEN, N W (DPM)
Entity Type:Individual
Prefix:DR
First Name:N
Middle Name:W
Last Name:WORDEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1128
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46546-1128
Mailing Address - Country:US
Mailing Address - Phone:574-258-5060
Mailing Address - Fax:574-258-5076
Practice Address - Street 1:2206 LINCOLN WAY E
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-3301
Practice Address - Country:US
Practice Address - Phone:574-258-5060
Practice Address - Fax:574-258-5076
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000536A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100091760Medicaid
IN410026672OtherRAILROAD MEDICARE
IN410026672OtherRAILROAD MEDICARE
IN100091760Medicaid
IN0260150001Medicare NSC
IN167440AMedicare PIN