Provider Demographics
NPI:1760797963
Name:WESCOGAME, CARRIE-ANN (RN)
Entity Type:Individual
Prefix:
First Name:CARRIE-ANN
Middle Name:
Last Name:WESCOGAME
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 1:820 W AHONEN RD
Mailing Address - Street 2:
Mailing Address - City:PAULDEN
Mailing Address - State:AZ
Mailing Address - Zip Code:86334-2848
Mailing Address - Country:US
Mailing Address - Phone:928-717-3241
Mailing Address - Fax:
Practice Address - Street 1:820 W AHONEN RD
Practice Address - Street 2:
Practice Address - City:PAULDEN
Practice Address - State:AZ
Practice Address - Zip Code:86334-2848
Practice Address - Country:US
Practice Address - Phone:928-717-3241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN164356163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool