Provider Demographics
NPI:1639429483
Name:WORDEN, ANDI L (RN)
Entity Type:Individual
Prefix:
First Name:ANDI
Middle Name:L
Last Name:WORDEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 WREN ST
Mailing Address - Street 2:
Mailing Address - City:EAST TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02718-5132
Mailing Address - Country:US
Mailing Address - Phone:508-369-3680
Mailing Address - Fax:
Practice Address - Street 1:355 WREN ST
Practice Address - Street 2:
Practice Address - City:EAST TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02718-5132
Practice Address - Country:US
Practice Address - Phone:508-369-3680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2260194163WH0200X
RIRN51062163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health