Provider Demographics
NPI:1538107958
Name:WOOTEN, CAROL ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5983 AMANDA NORTHERN RD
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:OH
Mailing Address - Zip Code:43112-9619
Mailing Address - Country:US
Mailing Address - Phone:614-833-3397
Mailing Address - Fax:614-833-3307
Practice Address - Street 1:5983 AMANDA NORTHERN RD
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:OH
Practice Address - Zip Code:43112-9619
Practice Address - Country:US
Practice Address - Phone:614-830-7428
Practice Address - Fax:614-307-4280
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 106543164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse